Islam Jessica Y, Suneja Gita, Lin Yu Chen, McGee-Avila Jennifer K, Turner Kea, Alishahi Tabriz Amir, Vadaparampil Susan T, D'Souza Gypsyamber, Friedman M Reuel, Guo Yi, Camacho-Rivera Marlene
Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center Research Institute, Tampa, Florida, USA.
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
Cancer. 2025 May 1;131(9):e35881. doi: 10.1002/cncr.35881.
People with HIV (PWH) are less likely to receive cancer treatment compared to those without HIV. The objective of this study was to evaluate the role of area-level social determinants of health (SDoH) in cancer treatment receipt among PWH and cancer in the United States.
The authors used the National Cancer Database (NCDB; 2004-2020) and included adult patients (18-89 years) with HIV, identified via International Classification of Diseases (ICD)-9 and ICD-10 codes. We focused on the 14 most common cancers common among PWH. The primary outcome was receipt of first-line curative cancer treatment as documented by NCDB. Key SDoH exposures were area-level educational attainment (percent of adults without a high school degree) and income (median income quartiles) by zip code. Hierarchical multivariable logistic regression models, clustered by cancer treatment facility, were used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
The authors included 31,549 people with HIV and cancer, 16.5% of whom did not receive first-line curative cancer treatment. Overall, 43% were ≥60 years old, 38% were non-Hispanic Black, 68% were male, and 39% resided in the Southern United States. The most common cancers were lung (21%), diffuse large B-cell lymphoma or DLBCL (12%), colorectal (9%), and prostate (9%). PWH living in areas of lowest educational attainment (quartile [Q]4 vs. Q1: aOR, 0.73; 95% CI, 0.66-0.82) and lowest-income (Q4 vs. Q1: aOR, 0.73; 95% CI, 0.65-0.81) areas were less likely to receive cancer treatment, after adjusting for age, sex, stage, year, and cancer type.
Area-level SDoH are associated with cancer treatment receipt among PWH, suggesting structural factors may impact this long-standing observed inequity.
与未感染艾滋病毒的人相比，感染艾滋病毒的人（PWH）接受癌症治疗的可能性更低。本研究的目的是评估美国地区层面的健康社会决定因素（SDoH）在PWH癌症治疗接受情况以及癌症发生中的作用。
作者使用了国家癌症数据库（NCDB；2004 - 2020年），纳入了通过国际疾病分类（ICD）-9和ICD-10编码识别的成年艾滋病毒患者（18 - 89岁）。我们重点关注PWH中最常见的14种癌症。主要结局是NCDB记录的接受一线根治性癌症治疗情况。关键的SDoH暴露因素是按邮政编码划分的地区层面教育程度（未获得高中学历的成年人百分比）和收入（收入中位数四分位数）。采用按癌症治疗机构聚类的分层多变量逻辑回归模型来估计调整后的优势比（aORs）及95%置信区间（CIs）。
作者纳入了31549名艾滋病毒合并癌症患者，其中16.5%未接受一线根治性癌症治疗。总体而言，43%的患者年龄≥60岁，38%为非西班牙裔黑人，68%为男性，39%居住在美国南部。最常见的癌症是肺癌（21%）、弥漫性大B细胞淋巴瘤或DLBCL（12%）、结直肠癌（9%）和前列腺癌（9%）。在调整年龄、性别、分期、年份和癌症类型后，生活在教育程度最低地区（四分位数[Q]4与Q1相比：aOR，0.73；95%CI，0.66 - 0.82）和低收入地区（Q4与Q1相比：aOR，0.73；95%CI，0.65 - 0.81）的PWH接受癌症治疗的可能性较小。
地区层面的SDoH与PWH的癌症治疗接受情况相关，表明结构性因素可能影响这一长期存在的不平等现象。
