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: 10132275
• 负责人: Corinne E. Joshu
• 金额: $ 67.71万
• 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/10132275
• 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; Prognosis; 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; 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 定义癌症（NADC）的非援助预计将占所有癌症的89％ 到2030年，HIV（PLWH），在较旧的PLWH中诊断出绝大多数。这种转变是因为， 与没有艾滋病毒的人相比，据报道，PLWH对于几个NADC的癌症特异性死亡率较高， 最常见的NADC诊断后的总体死亡率更高。高死亡率的解释 在NADC之后的PLWH中，可能是多因素的，目前尚不完全理解。大约给出 45％的PLWH是50年，其中84％的PLWH在50到64之间，至关重要 在艾滋病毒，NADC和该人群的健康衰老之间。告知有效NADC的发展 预防和治疗策略针对老龄化PLWH人群，能够解散 艾滋病毒从与艾滋病毒相关的社会行为因素中的影响。为此，一个比较组 需要燃烧风险因素，社会经济地位和获得护理的机会。大约 美国40％的PLWH被医疗补助覆盖。医疗补助受益人是潜水员，包括 PLWH的比较组具有类似的风险因素伯恩并获得护理。医疗补助人口是 现有艾滋病毒资源的重要完成，包括（1）捕获癌症事件的资源 下游事件，例如HIV-CACTER匹配队列，（2）包括丰富的队列数据，但有限 特定类型的癌症病例可以检查种族和性别差异，例如NA-Accord，（3） 其他基于索赔的队列，捕获艾滋病毒和普通人群的重要但不同的部分， 包括Seer-Medicare。我们建议评估超过500万医疗补助受益人的索赔50 在2001年至2017年，在抗逆转录病毒疗法的现代时代，有14个州的历史：（1）量化 PLWH中的癌症类型的年龄，种族/种族和性交事件（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 在NADC特定的诊断与定义疾病的新艾滋病和艾滋病毒护理中的保留之间以及（4）评估之间 是否通过癌症诊断HIV和NADC是否与年龄相关的风险更高有关 结果比较单独的HIV或NADC的诊断。这项研究的发现将告知衰老 艾滋病毒的存在会影响定义癌症的非AIDS的风险和后果，并影响艾滋病毒护理 以及老年人与年龄有关的结果。重要的是，我们将在低收入中评估我们的目标 男性和女性的潜水人群50岁，有比较人口具有可比风险因素的人口 并获得护理。