Inequities in palliative care delivery to patients with HIV and stage IV cancers in the United States (2004-2020).

Abstract

Background: People with HIV diagnosed with stage IV cancer are less likely to receive palliative care compared with those without HIV. Our objective was to evaluate inequities in palliative care receipt among people with HIV with stage IV cancer in the United States.

Methods: We used the National Cancer Database (2004-2020), including adults (aged 18-89 years) with HIV with the 14 most common cancers that occur among people with HIV. Palliative care was defined as treatment provided with noncurative intent. Our main exposures included percent quartiles (Q) of adults without a high school degree (educational attainment) and median income quartiles within the patient's zip code. We used hierarchical multivariable Poisson regression to estimate adjusted prevalence ratios with 95% confidence intervals (CIs), adjusting for age, sex, year of diagnosis, race and ethnicity, and cancer type.

Results: Among the included 10 120 people with HIV with stage IV cancer, 72% were men, 51% were either non-Hispanic Black or Hispanic or Latinx, 38% were aged 60 years and older, and 97% resided in urban areas; 14% received palliative care. Non-Hispanic Black people with HIV living in zip codes with lower quartiles of educational attainment were more likely to receive palliative care compared with those in the highest quartile (Q1 vs Q4: adjusted prevalence ratio = 1.93, 95% CI = 1.29 to 2.86). For income overall, compared with those in the highest quartile (Q4) of income, those in the lowest quartile had 26% higher likelihood of receiving palliative care (Q1 vs Q4: adjusted prevalence ratio = 1.26, 95% CI = 1.05 to 1.52), particularly among non-Hispanic Black adults (Q1 vs Q4: adjusted prevalence ratio = 1.67, 95% CI =1.25 to 2.22; Q2 vs Q4: adjusted prevalence ratio = 1.48, 95% CI = 1.09 to 2.01).

Conclusions: Palliative care use among people with HIV with stage IV cancer is low. Contextual poverty plays a role in palliative care delivery to people with HIV and cancer, particularly among non-Hispanic Black people with HIV.