Islam Jessica Y, Guo Yi, McGee-Avila Jennifer K, Turner Kea, Tabriz Amir Alishahi, Lin Yu Chen, Vadaparampil Susan T, Coghill Anna E, Camacho-Rivera Marlene, Suneja Gita
Center for Immunization and Infection in Cancer, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
BMC Cancer. 2025 May 20;25(1):897. doi: 10.1186/s12885-025-14272-z.
People with HIV (PWH) are less likely to receive cancer treatment compared to those without HIV. Social factors, such as cancer treatment facility type, which may impact cancer treatment receipt among PWH have not been quantitatively explored. Our objective was to characterize racial differences in social determinants of health (SDoH) that impact cancer treatment receipt among PWH and cancer in the US.
We used the National Cancer Database (2004-2020) and included adult (18-89 years) patients living with HIV identified using ICD9 and ICD10 codes. We included the 14 most common cancers that occur among PWH. Our main outcome was receipt of first-line cancer treatment, including systemic therapy, surgery, hormone therapy, and radiotherapy. Our main SDoH exposures included (1) area-level education or % of adults without a high school degree and (2) area-level income or median income quartiles within the patient's zip code. Healthcare access measures we evaluated included insurance status, distance to care, and cancer care facility type. We used hierarchical multivariable logistic regression models to estimate adjusted logistic ratios (aOR) with 95% confidence intervals (95% CI).
We included 31,549 patients with HIV and cancer, of which 16% did not receive treatment. Overall, 43% of patients were aged ≥ 60 years, 38% were NH-Black, 68% were male, and 39% of patients resided in the South. 47% of patients were diagnosed with stage I/II cancer, and the most common cancers included were lung (21%), diffuse large B-cell lymphoma (12%), colorectal (9%) cancers, and prostate(9%). Compared to those in the highest quartile (Q4), PWH in the lower quartiles of educational attainment were less likely to receive cancer treatment (Q1 vs. Q4: aOR:0.74; 95% CI:0.66-0.82). Residing in the lower quartiles of household income was also inversely associated with cancer treatment receipt (Q1 vs.Q4: aOR:0.73; 95% CI:0.65-0.82). These associations were consistent among NH-White and NH-Black PWH. PWH living within 2 miles of their cancer care facility (vs. >45 miles away) and those treated at community cancer programs (vs. an academic/research program) were less likely to receive cancer treatment.
Area-level markers of social disadvantage are associated with cancer treatment receipt among PWH, suggesting SDoH factors may impact inequities in cancer treatment by HIV status.
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较小。社会因素，如癌症治疗机构类型，可能会影响PWH接受癌症治疗的情况，但尚未进行定量研究。我们的目标是描述影响美国PWH癌症治疗接受情况的健康社会决定因素（SDoH）中的种族差异。
我们使用了国家癌症数据库（2004 - 2020年），纳入了使用ICD9和ICD10编码识别的成年（18 - 89岁）艾滋病毒感染者。我们纳入了PWH中最常见的14种癌症。我们的主要结局是接受一线癌症治疗，包括全身治疗、手术、激素治疗和放疗。我们主要的SDoH暴露因素包括：（1）地区层面的教育程度或未获得高中文凭的成年人比例；（2）地区层面的收入或患者邮政编码内的收入中位数四分位数。我们评估的医疗保健可及性指标包括保险状况、就医距离和癌症治疗机构类型。我们使用分层多变量逻辑回归模型来估计调整后的逻辑比（aOR）及95%置信区间（95%CI）。
我们纳入了31549名艾滋病毒感染者和癌症患者，其中16%未接受治疗。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%的患者居住在南方。47%的患者被诊断为I/II期癌症，最常见的癌症包括肺癌（21%）、弥漫性大B细胞淋巴瘤（12%）、结直肠癌（9%）和前列腺癌（9%）。与处于最高四分位数（Q4）的患者相比，教育程度较低四分位数的PWH接受癌症治疗的可能性较小（Q1与Q4相比：aOR：0.74；95%CI：0.66 - 0.82）。家庭收入处于较低四分位数也与接受癌症治疗呈负相关（Q1与Q4相比：aOR：0.73；95%CI：0.65 - 0.82）。这些关联在非西班牙裔白人和非西班牙裔黑人PWH中是一致的。居住在距离癌症治疗机构2英里以内（与距离>45英里相比）的PWH以及在社区癌症项目接受治疗的患者（与学术/研究项目相比）接受癌症治疗的可能性较小。
社会劣势的地区层面指标与PWH接受癌症治疗有关，这表明SDoH因素可能会影响按艾滋病毒感染状况划分的癌症治疗不平等情况。
