Abstract A114: Inequities in advanced stage at diagnosis of non-small cell lung cancer among people with and without HIV in the US
Authors: Islam Jessica Y , Guo Yi , Turner Kea , Tabriz Amir Alishahi , Camacho-Rivera Marlene , Suneja Gita 
Published: September 2024

Abstract
Background: Lung cancer is the leading cause of non-AIDS death among people with HIV (PWH). PWH are also more likely to die due to lung cancer compared to people with HIV. Late presentation at diagnosis due to barriers to lung cancer screening may contribute to disproportionate deaths among PWH. Our objective was to evaluate associations of HIV status with advanced stage at diagnosis and evaluate social determinants of health (SDoH) associated with advanced stage at diagnosis of lung cancer among PWH. Methods: We used data from the 2004-2020 National Cancer Database, including patients aged 18-89 years diagnosed with lung cancer (ICD-0-3 codes: C340-C349). PWH were identified using ICD9 (04200 to 04499, 07953, and V08) and ICD10 (B20 to B24, R75, Z21, B97.35).The primary outcome was advanced stage at diagnosis (stage 3/4). Our main SDoH exposures were quantified as quartiles (Q1-Q4) and included measures of area-level SDoH based on a patient’s zip code: (1) % of adults without a high school degree, or area-level education; (2) median household income of adults, or area-level income. We used hierarchical multivariable logistic regression models clustered by facility ID to estimate adjusted odds ratios(aOR) with 95% confidence intervals(95% CI), and evaluated each exposure separately adjusting for age, sex, year of diagnosis, and Charlson comorbidity score, and stratified by race/ethnicity and insurance status. Results: Overall, we identified 6,585 PWH and 1,665,030 without HIV. Seventy one percent of PWH were diagnosed with stage 3 or 4 lung cancer compared to 64.9% of people without HIV (p&lt;0.001). PWH were more likely to be under the age of 60 (43.5% vs.15.1%, p&lt;0.001), After adjustment for sex, age, and year of diagnosis, PWH had 15% higher odds of advanced stage at diagnosis compared to those without HIV (aOR: 1.15; 95% CI: 1.09-1.22). Residing in areas with larger proportions of the population without a HS diploma (Q4 vs. Q1: aOR:1.19; 95% CI: 1.01-1.41) and larger proportions with lower household income (Q1 vs. Q4: aOR: 1.15; 95% CI: 1.01-1.31) were positively associated with advanced stage-at-diagnosis of lung cancer. When we stratified by insurance status, only PWH who were Medicaid insured residing in the least educated areas (aOR: 1.84; 95% CI: 1.11-3.06) and in the lowest income areas (aOR: 1.86; 95% CI: 1.30-2.65) had higher odds of advanced stage at diagnosis with lung cancer. Conclusions: Living with HIV is independently associated with presenting at a later stage of lung cancer at diagnosis. Area-level measures of lower education and lower household income are significantly associated with advanced stage-at- diagnosis of lung cancer regardless, particularly among those who are Medicaid insured.
Citation Format: Jessica Y Islam, Yi Guo, Kea Turner, Amir Alishahi Tabriz, Marlene Camacho-Rivera, Gita Suneja. Inequities in advanced stage at diagnosis of non-small cell lung cancer among people with and without HIV in the US [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A114.