Islam Jessica Y, Guo Yi, Turner Kea, Tabriz Amir Alishahi, Lin Yu Chen, Vidot Denise C, Vadaparampil Susan T, Coghill Anna E, Camacho-Rivera Marlene, Suneja Gita
Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States.
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States.
JNCI Cancer Spectr. 2025 Mar 3;9(2). doi: 10.1093/jncics/pkae118.
People with HIV diagnosed with stage IV cancer are less likely to receive palliative care compared with those without HIV. Our objective was to evaluate inequities in palliative care receipt among people with HIV with stage IV cancer in the United States.
We used the National Cancer Database (2004-2020), including adults (aged 18-89 years) with HIV with the 14 most common cancers that occur among people with HIV. Palliative care was defined as treatment provided with noncurative intent. Our main exposures included percent quartiles (Q) of adults without a high school degree (educational attainment) and median income quartiles within the patient's zip code. We used hierarchical multivariable Poisson regression to estimate adjusted prevalence ratios with 95% confidence intervals (CIs), adjusting for age, sex, year of diagnosis, race and ethnicity, and cancer type.
Among the included 10 120 people with HIV with stage IV cancer, 72% were men, 51% were either non-Hispanic Black or Hispanic or Latinx, 38% were aged 60 years and older, and 97% resided in urban areas; 14% received palliative care. Non-Hispanic Black people with HIV living in zip codes with lower quartiles of educational attainment were more likely to receive palliative care compared with those in the highest quartile (Q1 vs Q4: adjusted prevalence ratio = 1.93, 95% CI = 1.29 to 2.86). For income overall, compared with those in the highest quartile (Q4) of income, those in the lowest quartile had 26% higher likelihood of receiving palliative care (Q1 vs Q4: adjusted prevalence ratio = 1.26, 95% CI = 1.05 to 1.52), particularly among non-Hispanic Black adults (Q1 vs Q4: adjusted prevalence ratio = 1.67, 95% CI =1.25 to 2.22; Q2 vs Q4: adjusted prevalence ratio = 1.48, 95% CI = 1.09 to 2.01).
Palliative care use among people with HIV with stage IV cancer is low. Contextual poverty plays a role in palliative care delivery to people with HIV and cancer, particularly among non-Hispanic Black people with HIV.
与未感染艾滋病毒的人相比，被诊断患有IV期癌症的艾滋病毒感染者接受姑息治疗的可能性较小。我们的目标是评估美国患有IV期癌症的艾滋病毒感染者在接受姑息治疗方面的不平等情况。
我们使用了国家癌症数据库（2004 - 2020年），其中包括年龄在18 - 89岁之间、患有艾滋病毒且患14种艾滋病毒感染者中最常见癌症的成年人。姑息治疗被定义为以非治愈为目的提供的治疗。我们的主要暴露因素包括没有高中学历的成年人百分比四分位数（Q）以及患者邮政编码内的收入中位数四分位数。我们使用分层多变量泊松回归来估计调整后的患病率比值及95%置信区间（CI），并对年龄、性别、诊断年份、种族和民族以及癌症类型进行了调整。
在纳入的10120名患有IV期癌症的艾滋病毒感染者中，72%为男性，51%为非西班牙裔黑人或西班牙裔或拉丁裔，38%年龄在60岁及以上，97%居住在城市地区；14%接受了姑息治疗。与教育程度最高四分位数地区的艾滋病毒感染者相比，居住在教育程度较低四分位数邮政编码地区的非西班牙裔黑人艾滋病毒感染者更有可能接受姑息治疗（Q1与Q4：调整后的患病率比值 = 1.93，95% CI = 1.29至2.86）。总体而言，与收入最高四分位数（Q4）的人相比，收入最低四分位数的人接受姑息治疗有26%的更高可能性（Q1与Q4：调整后的患病率比值 = 1.26，95% CI = 1.05至1.52），特别是在非西班牙裔黑人成年人中（Q1与Q4：调整后的患病率比值 = 1.67，95% CI = 1.25至2.22；Q2与Q4：调整后的患病率比值 = 1.48，95% CI = 1.09至2.01）。
患有IV期癌症的艾滋病毒感染者中姑息治疗的使用率较低。背景性贫困在为艾滋病毒感染者和癌症患者提供姑息治疗方面发挥了作用，特别是在非西班牙裔黑人艾滋病毒感染者中。
