Healthcare utilization and outcomes in cervical cancer with and without HIV: National inpatient sample analysis.

Abstract

e17522 Background: Cervical cancer (CC) is an AIDS-defining malignancy and is the most common cancer in women with HIV who have a six times higher risk of developing CC than women without HIV. Compared to non-HIV-CC, HIV-CC has a reported 2-fold higher mortality. We attempted to evaluate the characteristics, outcomes and healthcare utilization of patients with CC with and without HIV from a national sample. Methods: We identified all patients of CC with and without HIV between 2016 – 2018 from Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database. The groups were compared for socio-demographic differences, medical comorbidities, inpatient mortality, length of stay (LOS) and total hospital charges (THC). Secondary outcomes (SO) included rates of sepsis, septic shock, pain, acute kidney injury, urinary tract infection, hydronephrosis, nephrostomy, anemia, and protein energy malnutrition (PEM). Statistics were performed using t-test, univariate and multinomial logistic regression. Results: A total 755 admissions with HIV-CC and 71, 690 with non-HIV-CC were identified. Patients of HIV-CC were more likely to be younger (Mean age: 48.7 vs 53.4, p < 0.001), African American (62.8% vs 18.4%, p < 0.001), have Medicaid (52.3% vs 34.5%, p < 0.001), admitted to a teaching hospital (90.7% vs 78.7%, p < 0.01), live in lowest income ZIP codes (62.2% vs 36.2%, p < 0.01) and in Northeast region of USA (30.5% vs 17.3%, p < 0.01). HIV-CC had significantly higher rates of chronic kidney disease (CKD) and hemodialysis (HD) (p < 0.05), lower rates of hypertension (p < 0.05) with other comorbidities being similar between groups. The overall adjusted all cause mortality was significantly lower in HIV-CC (aOR = 0.15, CI 0.05-0.39, p < 0.001) but mean LOS (8.3 vs 5.6 days, p < 0.01) and THC ($86, 171 vs $63, 138, p < 0.01) was significantly higher than non-HIV-CC. The rates of anemia (70.2% vs 52.8%) and PEM (27.8% vs 20.5%) were significantly higher (p < 0.05) in HIV-CC while other SOs were non-significant. Conclusions: HIV-CC inpatients were younger, minorities from low income zip codes and, unlike historic data, had significantly lower mortality compared to non-HIV-CC. Despite lower mortality, LOS and THC were significantly higher in HIV-CC, amounting to over $17 million in 3 years. It may be related to a higher burden of CKD and HD, however more studies are needed to clarify our findings and identify causes of increased healthcare utilization in this group to save costs.