Aims
HIV patients have 1.7-4-fold higher incidence of Head and Neck Cancer (HNCA) than non-HIV patients with similar risk factors and outcomes, based on small studies (doi:10.1097/QAI.0000000000000083). We aim to evaluate differences in demographics, outcomes, healthcare utilization (HU) using a national database.
Methods
US Healthcare-Cost-Utilization-Project’s Nationwide-Inpatient-Sample (HCUP-NIS) 2016-2018 was queried to identify HIV and non-HIV-HNCA admissions using ICD-10 codes. Demographics, comorbidities, mortality, length of stay (LOS), total hospital charges (THC) and secondary outcomes were compared. Statistical analysis used Chi-square, univariate and multinomial logistic regression.
Results
There were 1515 HIV-HNCA and 217,320 non-HIV-HNCA admissions. HIV-HNCA patients were younger (mean age 56 vs 64.2 years, p<0.001), men (78.5%vs72.4%, p=0.035), Black (50.8%vs12.3%, p<0.0001), on Medicaid (36.3%vs16.8%, p<0.0001) and from lowest quartile income zip codes (48.2%vs30.2%, p<0.0001). Rates of smoking were higher in non-HIV-HNCA (39.6%vs28.1%, p<0.0001) while rates of alcoholism were similar. HIV-HNCA had higher CKD, lower hypertension/CAD/Dyslipidemia/Obesity (all p <0.01) and similar Diabetes/COPD/heart failure (p=NS). HIV-HNCA had higher CKD rates (P<0.01). HIV-HNCA had higher rates of sepsis, malnutrition and pneumonia (all p<0.01), other secondary outcomes were similar.
Adjusted all-cause mortality was lower in HIV-HNCA (aOR 0.33, p<0.001) while mean LOS (8.5 vs 6.8 days, p<0.0001) and mean THC ($109,222 vs $82,022, p<0.0001) were higher compared to non-HIV-HNCA.
Conclusion
Contrary to reported studies, HIV-HNCA had lower smoking rates, lower all-cause mortality, with higher LOS and THC, despite adjustment for demographics/medical comorbidities. Future studies need to identify causes of HNCA in HIV and ways to decrease HU.