Lower Endoscopy, Early-Onset and Average-Onset Colon Cancer Among Medicaid Beneficiaries With and Without HIV: A Cohort Study

Background

Studies suggest a lower CRC risk and lower or similar CRC screening among PLWH compared to the general population. We evaluated the incidence of lower endoscopy and average-onset (diagnosed at ≥50) and early-onset (diagnosed at <50) colon cancer by HIV status among Medicaid beneficiares with comparable sociodemographic factors and access to care.

Methods

We obtained Medicaid Analytic eXtract (MAX) data from 2001–2015 for 14 states. We included 41,727,243 and 42,062,552 unique individuals with ≥7 months of continuous eligibility for the endoscopy and colon cancer analysis, respectively. HIV and colon cancer diagnoses and endoscopy procedures were identified from inpatient and other non-drug claims. We used Cox proportional hazards regression models to assess endoscopy and colon cancer incidence, controlling for age, sex, race/ethnicity, calendar year and state of enrollment, and comorbidities conditions.

Results

Endoscopy and colon cancer incidence increased with age in both groups. Compared to beneficiaries without HIV, PLWH had an increased hazard of endoscopy; this association was strongest among those 18–39 years (HR:1.85 95%CI:1.77–1.92) and attenuated with age. PLWH 18–39 years also had increased hazard of early-onset colon cancer (HR:1.66, 95%CI:1.05–2.62); this association was attenuated after comorbidity adjustment. HRs were null among all beneficiaries <50 years. PLWH had a lower hazard of average-onset colon cancer compared to those without HIV (HR: 0.79 95%CI:0.66–0.94).

Conclusions

PLWH had a higher hazard of endoscopy, particularly at younger ages. PLWH had a lower hazard of average-onset colon cancer. Early-onset colon cancer was higher among the youngest PLWH but not associated with HIV overall.