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

Abstract

e17010 Background: Prostate Cancer (PC) is the most common non-skin cancer and the 4th leading cause of cancer related deaths amongst men in the United States. The true incidence PC in patients with HIV is unknown and there is paucity of data on the outcomes of PC in HIV (HIV-PC) compared to non-HIV (non-HIV-PC) patient population. We undertook this study to understand the differences in demographics and outcomes in PC patients with or without HIV using a national sample. Methods: Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) was queried to identify all admissions in men with PC between 2016-2021. The patients on HIV and non-HIV were identified from this sample and compared for socio-demographic differences, medical comorbidities, all-cause mortality, mean length of stay (LOS) and mean total hospital charges (THC). Statistics were performed using the t-test, univariate and multinomial logistic regression. Results: Results: A total of 405 HIV-PC and 145,710 non-HIV-PC admissions were identified. Compared to non-HIV-PC, HIV-PC patients were significantly younger (67.1 vs 75.3 years, p<0.001) and more likely to be Black (60% vs 19%, p<0.0001) and Hispanic (17.5 vs 7.6%, p<0.0001), less likely to be White (21.35 vs 68.6%, p<0.0001). HIV-PC patients were also more likely to be from the lowest quartile income zip codes (41.8% vs 26%) but the difference was not significant (p=0.06). HIV-PC were more likely to be on Medicaid (18.8% vs 4.7%, p=0.001) and more likely to be treated at large hospitals (64.2% vs 49.6%, p=0.02). There two groups were equally likely to be treated at urban, rural, non-teaching and teaching hospitals. HIV-PC were most often from north-east, south and west regions of the US and least likely from Midwest (4.9% vs 22.4%, p=0.004). HIV-PC patients had significantly higher LOS (9.4 vs 6.1 days, p<0.0001) and higher THC ($150,326 vs $79,406, p<0.0001). These differences remained significant after adjustment for demographics and medical comorbidities (hypertension, diabetes, COPD, CKD, dialysis dependence, dyslipidemia, heart failure and obesity). The crude mortality rate was higher in HIV-PC (13.6% vs 5.5%, p=0.002). HIV-PC patients were more than twice more likely to die in hospital compared to non-HIV-PC (aOR 2.66, 95% CI 1.3-5.4, p=0.007) when adjusted for demographics and medical comorbidities listed above. Conclusions: HIV-PC patients were significantly younger minorities with significantly high mortality and healthcare utilization compared to their non-HIV counterparts, which remained significant after adjustment for the demographics and underlying comorbid medical conditions. More studies are needed to identify the causes for these differences and address them to improve outcomes in HIV patients with Prostate Cancer.