Regional and racial disparities in testicular cancer-related mortality among HIV/AIDS adults in the United States and Texas: A 21-year retrospective study (1999-2020).

Abstract

624 Background: Men with HIV/AIDS have a significantly higher risk of developing germ cell tumors (GCT), with a notable increase in the incidence of testicular cancer (TC). We aim to study the annual trends and sociodemographic factors in testicular cancer-related mortality in individuals with HIV/AIDS in the United States and its state of Texas from 1999 to 2020 to analyze public health initiatives and to identify areas requiring targeted intervention and prevention strategies. Methods: Mortality trends in TC among HIV/AIDS adults aged ≥25 years were analyzed using CDC WONDER database, identifying through ICD-10 codes C62.9 “Testicular neoplasms” and B20 “HIV/AIDS”. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs, with 95% confidence intervals, were determined using joint point regression analysis across various demographic (sex, race/ethnicity, age) and geographic (state, urban-rural, regional) subgroups. Results: Between 1999 and 2020, 89721 documented deaths were attributed to TC due to HIV. The overall AAMR for TC-related mortality in HIV/AIDS adults increased in the US from an adjusted rate (AR) 0.8 in 1999 to (2.9) in 2004 (APC: 4.17%; 95% CI: -2.76% to 38.8%), then it decreased to 1.5 in 2020 (APC: -5.01%; 95% CI: -15.5% to -3.94%). In Texas, AAMR for TC in immunocompromised adults increased from AR 1.5 in 1999 to 3.5 in 2001 (APC: 42.3%; 95% CI: 10.5% to 74.8%), after which it decreased to 1.9 in 2020 (APC: -0.03%; 95% CI: -1.47% to 1.89%). The AAMR in U.S. men increased from 1.4 in 1999 to 4.1 in 2001 (APC: 27.6%; 95%CI: -1.34% to 59.1%) and then decreased to 2.4 in 2020 (APC: -3.99%; 95% CI: -6.09% to -3.27%). The non-Hispanic (NH) Black or African American (AA) (4.9) population has the greatest AAMR, followed by the NH American Indian or Alaska Native (1.9) and the Hispanic or Latino population with AAMR (1.7). The lower-risk population was NH White with AAMR (0.9) and NH Asian or Pacific Islander (0.4). AAMR also varied by region (South: 1.9; Northeast: 1.5; West: 1.3; Midwest: 1) and metropolitan areas had higher AAMR (large central metropolitan: 2.3; large fringe areas: 1.4) than non-metropolitan areas (small metro: 1.1; micropolitan: 1.1; non-core areas: 1.2). The states in the upper 90th percentile of AAMRs were New York, Maryland, South Carolina, Georgia, Florida, Mississippi, Louisiana, and New Jersey exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile i.e Idaho, Wyoming, Utah, Wisconsin, Minnesota and North Dakota. Conclusions: Mortality rates from testicular cancer among HIV/AIDS adults have declined in the United States and Texas over the past two decades. However, NH Black or AA, NH American Indian or Alaska Native, Hispanic or Latino men are at more risk than NH White and NH Asian or Pacific Islander.