Medicaid data as a complement to cohort studies for investigating cancers among older people with HIV

医疗补助数据作为队列研究的补充，用于调查老年艾滋病毒感染者的癌症

• 批准号: 10013582
• 负责人: Corinne E. Joshu
• 金额: $ 67.95万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-24 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10013582
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Admission activity; Affect; Age; Age-Years; Aging; Cancer Control; Caring; Cessation of life; Chemotherapy and/or radiation; Chronic; Clinical Management; Cohort Studies; Colorectal Cancer; Complement; Continuity of Patient Care; Data; Dementia; Development; Diagnosis; Elderly; Enrollment; Ethnic Origin; Event; Female; Fracture; General Population; HIV; HIV Infections; HIV diagnosis; Health Services Accessibility; High Prevalence; Incidence; Infection; Knowledge; Length of Stay; Low income; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Medicaid; Medicare; Modernization; Older Population; Oncology; Operative Surgical Procedures; Outcome; Polypharmacy; Population; Population Heterogeneity; Poverty; Prevention strategy; Race; Radiation therapy; Resources; Risk; Risk Factors; Sample Size; Sex Differences; Smoking; Social Behavior; Socioeconomic Status; Subgroup; Time; Treatment-Related Cancer; Woman; age related; aging population; antiretroviral therapy; base; beneficiary; cancer diagnosis; cancer prevention; cancer therapy; cancer type; cohort; comorbidity; comparison group; demographics; experience; healthy aging; high risk; malignant breast neoplasm; men; mortality; multidisciplinary; outcome forecast; racial difference; sex; therapy adherence; treatment strategy

ABSTRACT Non-AIDS defining cancers (NADCs) are projected to account for 89% of all cancers among people living with HIV (PLWH) by 2030, with the vast majority diagnosed among older PLWH. This shift is concerning because, as compared to people without HIV, PLWH reportedly have higher cancer-specific mortality for several NADCs, and higher overall mortality after diagnosis of the most common NADCs. The explanation for higher mortality among PLWH after a NADC is likely multifactorial and, at present, not fully understood. Given approximately 45% of PLWH are 50 years, with 84% of those between 50 and 64, it is critical to understand the intersection between HIV, NADCs, and healthy aging in this population. To inform the development of effective NADC prevention and treatment strategies for the aging PLWH population, it is important to be able to disentangle the influence of HIV from the socio-behavioral factors associated HIV acquisition. To do this, a comparison group with a comparable burden of risk factors, socioeconomic status, and access to care is needed. Approximately 40% of PLWH in the US are covered by Medicaid. Medicaid beneficiaries are a diverse population, and include a comparison group for PLWH with similar risk factor burden and access to care. The Medicaid population is an important complement to existing HIV resources, including those that (1) capture cancer incidence but not downstream events, such as the HIV-Cancer Match cohort, (2) include rich cohort data, but have limited specific types of cancer cases to allow for examining race and sex differences, like the NA-ACCORD, and (3) other claims-based cohorts which capture, important, but different segments of the HIV and general population, including SEER-Medicare. We propose to assess claims for more than 5 million Medicaid beneficiaries 50 years old from 14 states between 2001 and 2017, in the modern era of antiretroviral therapy, to: (1) quantify the age-, race/ethnicity-, and sex- specific incidence of NADCs by cancer type among PLWH (2) evaluate the association between HIV-infection and NADC-specific treatment-related outcomes, (3) evaluate the association between NADC-specific diagnosis and new AIDS-defining illnesses and retention in HIV care, and (4) evaluate whether a diagnosis of both HIV and NADC, by cancer type, is associated with a higher risk of age-related outcomes as compared a diagnosis of HIV or NADC alone. Findings from this study will inform how aging in the presence of HIV affects the risk and consequences of non-AIDS defining cancers, and impacts HIV care and age-related outcomes among older adults. Importantly, we will evaluate our aims among a low-income, diverse population of men and women 50 years old with a comparison population with comparable risk factors and access to care.

抽象的 预计非艾滋病定义癌症 (NADC) 占艾滋病患者所有癌症的 89% 到 2030 年，艾滋病毒感染者 (PLWH) 绝大多数会在老年感染者中确诊，这种转变令人担忧，因为： 据报道，与未感染艾滋病毒的人相比，艾滋病病毒感染者的几种 NADC 的癌症特异性死亡率更高， 最常见的 NADC 诊断后总体死亡率更高。 NADC 后 PLWH 的影响可能是多因素的，目前尚未完全了解。 45% 的 PLWH 年龄≥50 岁，其中 84% 年龄在 50 岁至 64 岁之间，了解交叉点至关重要 HIV、NADC 和该人群健康老龄化之间的关系 为开发有效的 NADC 提供信息。 针对老龄化 PLWH 人群的预防和治疗策略，重要的是能够解开这些问题 与艾滋病毒感染相关的社会行为因素对艾滋病毒的影响进行了比较。 大约需要具有相当的风险因素负担、社会经济地位和获得护理的机会。 美国 40% 的 PLWH 享受医疗补助计划，受益人是多元化的人群，其中包括。 具有相似危险因素负担和获得医疗补助的人群的对照组是 PLWH。 对现有艾滋病毒资源的重要补充，包括 (1) 捕获癌症发病率但未捕获癌症发病率的资源 下游事件，例如 HIV-癌症匹配队列 (2) 包含丰富的队列数据，但有限 特定类型的癌症病例，以便检查种族和性别差异，例如 NA-ACCORD，以及 (3) 其他基于声明的队列捕获了艾滋病毒和普通人群中重要但不同的部分， 我们建议评估超过 500 万医疗补助受益人的索赔 50。 2001 年至 2017 年间，在抗逆转录病毒治疗的现代时代，来自 14 个州的研究人员：(1) 量化 PLWH 中按癌症类型划分的年龄、种族/族裔和性别特异性 NADC 发病率 (2) 评估 HIV 感染与 NADC 特异性治疗相关结果之间的关联，(3) 评估关联 NADC 特异性诊断与新的 AIDS 定义疾病以及 HIV 护理保留之间的关系，以及 (4) 评估 根据癌症类型，同时诊断出 HIV 和 NADC 是否与年龄相关的较高风险相关 与单独诊断 HIV 或 NADC 相比，本研究的结果将告诉您衰老的情况。 HIV 的存在会影响非艾滋病定义的癌症的风险和后果，并影响 HIV 护理 重要的是，我们将在低收入人群中评估我们的目标。 年龄≥50 岁的不同男性和女性人群，以及具有可比危险因素的比较人群 和获得护理的机会。