Incidence of frailty-related fracture among Medicaid beneficiaries living with HIV and cancer: A cohort study

Abstract

Background People living with HIV (PLWH) are at increased risk for frailty-related fracture. Limited evidence suggests recent diagnosis of non-AIDS defining cancer (NADC) is a risk factor for fracture among PLWH. We evaluated frailty-related fracture by HIV and cancer status to inform the burden of fracture among PLWH. Methods We included 14,554,711 beneficiaries without HIV and 159,188 beneficiaries with HIV who were 30–64 years old enrolled in Medicaid between 2001–2015 in 14 states. HIV, NADC, and fracture diagnoses were identified from inpatient and other non-prescription claims. We calculated age-specific fracture incidence per 100 person-years and 95% confidence intervals for beneficiaries with no NADC or HIV, NADC only, HIV only, or both. We estimated the cumulative incidence of frailty-related fracture with death as a competing event for each group. Results Fracture incidence increased with age in all groups. Compared to beneficiaries without NADC or HIV, all groups had significantly higher age-specific incidence of fracture. Beneficiaries with HIV and NADC had higher incidence of frailty-related fracture than those with HIV only at all ages (Incidence per 100 person-years for ages 30–44 Both: 1.24 95%CI:0.96,1.59; HIV: 0.74 95%CI:0.71,0.77; for ages 60–64 Both: 2.11 95%CI:1.64,2.67; HIV: 1.47 95%CI:1.37,1.58). Conversely, cumulative incidence was lowest for both HIV and NADC, likely due to in part to the very high incidence of death. Conclusion Beneficiaries with HIV and NADC had higher age-specific frailty-related fracture and death than beneficiaries with HIV alone. Future work should investigate fracture risk among PLWH with cancer to inform interventions for fracture prevention.