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Background <p>People with HIV (PWH) have higher lung cancer incidence and poorer prognosis than people without HIV (PWoH). PWoH experience age and sex-based differences in lung cancer. However, evidence on sex- and age-specific trends among PWH are limited.</p> Methods <p>We evaluated lung cancer incidence for Medicaid beneficiaries aged 30–64 from 14 states (2001–2015) by HIV status. We used Cox models and inverse probability weighting to estimate the hazard ratio (HR) of lung cancer and the Aalen-Johansen estimator to calculate the cumulative incidence of lung cancer by HIV status. We estimated the excess mortality ratio (EMR) by comparing the ratio of mortality rate differences before and after lung cancer diagnosis by HIV status.</p> Results <p>There were 1,110 lung cancers over 529,150 person-years among PWH and 8,256 lung cancers over 8,110,847 person-years among PWoH. HIV was associated with the hazard of lung cancer incidence (HR: 1.75, 95% CI:1.56, 1.96); the strongest association was among female beneficiaries aged 30–49 (HR: 3.71, 95% CI: 2.59, 5.32). Lung cancer incidence rates declined over time for all beneficiaries; however, the smallest decrease was in female PWH. PWH experienced significant excess mortality after lung cancer diagnosis compared to PWoH (EMR:1.24, 95% CI:1.06, 1.43); this was strongest among female beneficiaries aged 30–49 (EMR: 2.18, 95% CI: 1.46, 3.12).</p> Conclusions <p>PWH had elevated incidence of lung cancer and excess mortality after lung cancer compared to PWoH. Importantly, these findings were strongest among young female beneficiaries with HIV, highlighting the need for lung cancer prevention and early detection among this group.</p>

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Sex- and age- specific lung cancer incidence and mortality among Medicaid beneficiaries with and without HIV, 2001–2015

  • 期刊论文

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  • 发表日期：

    2026年7月7日

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  • Yiyi Zhou,
  • Bryan Lau,
  • Jacqueline E. Rudolph,
  • Xiaoqiang Xu,
  • Keri L. Calkins,
  • Maylin Palatino,
  • Karine Yenokyan,
  • Eryka L. Wentz,
  • Corinne E. Joshu

摘要

Background

People with HIV (PWH) have higher lung cancer incidence and poorer prognosis than people without HIV (PWoH). PWoH experience age and sex-based differences in lung cancer. However, evidence on sex- and age-specific trends among PWH are limited.

Methods

We evaluated lung cancer incidence for Medicaid beneficiaries aged 30–64 from 14 states (2001–2015) by HIV status. We used Cox models and inverse probability weighting to estimate the hazard ratio (HR) of lung cancer and the Aalen-Johansen estimator to calculate the cumulative incidence of lung cancer by HIV status. We estimated the excess mortality ratio (EMR) by comparing the ratio of mortality rate differences before and after lung cancer diagnosis by HIV status.

Results

There were 1,110 lung cancers over 529,150 person-years among PWH and 8,256 lung cancers over 8,110,847 person-years among PWoH. HIV was associated with the hazard of lung cancer incidence (HR: 1.75, 95% CI:1.56, 1.96); the strongest association was among female beneficiaries aged 30–49 (HR: 3.71, 95% CI: 2.59, 5.32). Lung cancer incidence rates declined over time for all beneficiaries; however, the smallest decrease was in female PWH. PWH experienced significant excess mortality after lung cancer diagnosis compared to PWoH (EMR:1.24, 95% CI:1.06, 1.43); this was strongest among female beneficiaries aged 30–49 (EMR: 2.18, 95% CI: 1.46, 3.12).

Conclusions

PWH had elevated incidence of lung cancer and excess mortality after lung cancer compared to PWoH. Importantly, these findings were strongest among young female beneficiaries with HIV, highlighting the need for lung cancer prevention and early detection among this group.