Epidemiology and healthcare burden of penile cancer in people living with HIV in the United States.

Abstract

e17029 Background: HIV- positive patients are known to have worse outcomes with a 4-fold increased risk for death from penile cancers. Despite this, data regarding the prevalence and healthcare utilization of penile cancer among people living with HIV (PLWH) are insufficient. Our study focuses on demographic, clinical and socioeconomic differences between HIV and non-HIV cohorts. Methods: We conducted a retrospective cohort study of adult patients with penile cancer, divided into HIV-positive and HIV-negative patients from the 2016-2022 National Inpatient Sample. Patient demographics, clinical comorbidities, hospital characteristics, and healthcare utilization were compared between groups. Categorical variables were analyzed using chi-square tests and continuous variables using t-tests, with statistical significance defined as p < 0.05, and adjusting for the complex structure of the NIS. Results: Among 15,825 penile cancer patients, 575 (3.6%) were HIV-positive. HIV-positive patients were significantly younger (mean age 55.98 vs. 65.80 years, p < 0.001) and had higher comorbidity burden (Charlson Index 8.51 vs. 5.24, p < 0.001). HIV-positive patients were more likely to be Black (66.09% vs. 9.33%, p < 0.001), have Medicaid (33.91% vs. 14.67%, p < 0.001), and fall in the lowest income quartile (59.62% vs. 32.35%, p < 0.001). They had higher rates of smoking (55.65% vs. 44.03%, p = 0.018), drug abuse (13.04% vs. 2.75%, p < 0.001), cachexia (6.96% vs. 2.23%, p = 0.001), chronic hepatitis B (6.09% vs. 0.13%, p < 0.001), and chronic hepatitis C (6.09% vs. 0.59%, p < 0.001). However, HIV-positive patients had lower rates of obesity (5.22% vs. 17.61%, p < 0.001), diabetes (26.96% vs. 37.05%, p = 0.028), dyslipidemia (22.61% vs. 36.23%, p = 0.007), hypertension (50.43% vs. 64.36%, p = 0.002), and metastatic cancer (24.35% vs. 42.10%, p < 0.001). Mean adjusted total hospital charges were significantly higher for HIV-positive patients ($115,939 vs. $76,717, p = 0.010). Conclusions: PLWH constituted a smaller but important subset of penile cancer patients in the U.S., characterized by younger age, higher comorbidity burden, a higher representation of Black patients and significant socioeconomic barriers including low income and Medicaid enrollment. These findings warrant further work on timely diagnosis and tailored supportive care for patients with penile cancer and HIV with attention to tackling the socioeconomic inequities in resource utilization.