Lung cancer in HIV versus non-HIV population: Nationwide analysis of mortality, morbidity, demographics, and healthcare utilization.

Abstract

9125 Background: Lung cancer (LC) is the most common non-AIDS defining cancer with a high cancer-related mortality in patients with HIV. With improving survival in HIV patients, the incidence of LC is increasing. We attempted to evaluate the characteristics and outcomes, including healthcare utilization in patients with HIV-LC compared to non-HIV-LC using a national sample. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) was queried to identify HIV and non-HIV-LC admissions between 2016-2018. We studied socio-demographic differences, medical comorbidities (including hypertension (HTN), diabetes (DM), Coronary artery disease (CAD), Chronic kidney disease (CKD), Heart failure (HF), dialysis (HD), COPD), all-cause mortality, mean length of stay (LOS), mean total hospital charges (THC). Secondary outcomes included sepsis, septic shock, acute kidney injury (AKI), influenza, pneumonia, respiratory failure, lung collapse, ICU care, hemoptysis, anemia, pain, and protein energy malnutrition (PEM). Statistics were performed using the t-test, univariate and multinomial logistic regression. Results: A total 4,105 HIV-LC and 1,204,365 non-HIV-LC admissions were identified. HIV-LC were younger (mean age 48.7 vs 53.4 p<0.05), male (67% vs 51%, p<0.01), African American (52% vs 12% p<0.01), on Medicaid (35% vs 10% p<0.01), from lowest quartile income zip codes (51% vs 30% p<0.01). HIV-LC had significantly high rates of CKD and HD (p<0.05) while non-HIV-LC had significantly higher rates of HTN, DM, Dyslipidemia, CAD, COPD, obesity, HF and smoking (all p<0.05). Odds of adjusted all-cause mortality were significantly lower in HIV-LC (aOR 0.47 CI 0.36-0.63 p<0.001). HIV-LC had higher LOS (8.1 vs 6 days p<0.001) and higher THC ($83,328 vs $65,642 p<0.001), amounting to over $72 million over 3 years. Significantly different secondary outcomes between the two groups are shown in Table, the rest were similar between the groups. Conclusions: HIV-LC patients were younger, minority with a significantly lower all-cause mortality despite higher rates of complications and significantly higher LOS and THC compared to non-HIV-LC cohort. A higher comorbidity burden may be responsible for higher mortality in the non-HIV group while higher rates of secondary complications, CKD, HD may be driving up healthcare utilization in HIV-LC. More studies are needed to clarify these findings.[Table: see text]