Background: Cancer is the leading cause of death among people with HIV (PWH) and may be a major contributor to mortality disparities among PWH. We sought to determine the relative contributions of specified cancers to racial/ethnic mortality disparities among PWH Methods: 2014-2017 deaths due to specified cancers and the number of PWH at risk (HIV prevalence) across the 50 US states were extracted, respectively, from CDC WONDER and HIV prevalence data for non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and Hispanics. Four-year mortality rates (number of deaths divided by HIV prevalence) were used to derive excess mortality (observed number of deaths minus number of expected deaths if the disparate group is assigned the lowest mortality rate) and population attributable proportion (PAP) for each cancer type with the racial/ethnic group having the lowest mortality rate serving as the reference group. Results: After excluding cancers with zero death counts for ≥1 racial/ethnic group, Hispanics had the lowest mortality rates for all cancers except cervical cancer. Excess mortality was highest among Blacks for Kaposi sarcoma (Mortality incidence proportion (MIP)=5.3/100,000 persons/year vs. 4.3 in Hispanics), Excess mortality (EM)=16 deaths), breast (MIP=8.9 vs. 5.4 in Hispanics, EM=21), prostate (MIP=3.2 vs 0.6 in Hispanics, EM=30), and vulvovaginal cancer (MIP=1.2 vs 0.6 in Hispanics, EM=4), among Whites for anal (MIP=5.8 vs 2.3 in Hispanics, EM=43), colorectal (MIP=9.7 vs 3.4 in Hispanics, EM=76), liver (MIP= 10.4 vs 6.7 in Hispanics, EM=51), lung (MIP=29.2 vs 5.4 in Hispanics, EM=286), oral (MIP=3.5 vs 0.9 in Hispanics, EM=31), and pancreatic cancer (MIP=6.4 vs 2.0 in Hispanics, EM=53), and non-melanoma (MIP=2.2 vs 0.5 in Hispanics, EM=21), and among Hispanics for cervical cancer (MIP=7.1 vs 4.1 in Blacks, EM=5). Total excess mortality ranged from 5 for Cervical Cancer to 541 for lung cancer. PAP ranged from 12.21% for cervical cancer to 72.73% for lung cancer and 76.78% for prostate cancer. 54% of non-AIDS defining cancer (NADC) deaths (Total EM=1,378) were attributable to racial/ethnic disparities vs 24% for AIDS-defining cancers (Total EM=232).
Conclusion: No single racial/ethnic group emerged as experiencing the greatest cancer-related mortality disparity but Hispanics appeared to have the lowest mortality rates. Overall, the greatest disparities among PLWH are observed with NADCs, particularly lung and prostate cancers. Interventions that target NADCs will significantly reduce the racial/ethnic disparity burden from cancer-related deaths.
Citation Format: Sabina O. Nduaguba, Janai Poullard, Robert L. Cook, Folakemi Odedina, Almut G. Winterstein. Cancer mortality disparities among people living with HIV in the U.S. [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-103.