The implementation of the ACA was associated with improved insurance coverage among patients living with HIV and cancer. Post-ACA, the percent uninsured was five times greater in non-Medicaid ...expansion states than Medicaid-expansion states, highlighting the need for further insurance expansion to ensure adequate access to cancer care.
Background
To the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act (ACA) on people living with HIV and cancer (PLWHC), who have lower cancer ...treatment rates and worse cancer outcomes. To investigate this research gap, the authors examined the effects of the ACA on insurance coverage and receipt of cancer treatment among PLWHC in the United States.
Methods
HIV‐infected individuals aged 18 to 64 years old with cancer diagnosed between 2011 and 2015 were identified in the National Cancer Data Base. Health insurance coverage and cancer treatment receipt were compared before and after implementation of the ACA in non–Medicaid expansion and Medicaid expansion states using difference‐in‐differences analysis.
Results
Of the 4794 PLWHC analyzed, approximately 49% resided in nonexpansion states and were more often uninsured (16.7% vs 4.2%), nonwhite (65.2% vs 60.2%), and of low income (36.3% vs 26.9%) compared with those in Medicaid expansion states. After 2014, the percentage of uninsured individuals decreased in expansion states (from 4.9% to 3%; P = .01) and nonexpansion states (from 17.6% to 14.6%; P = .06), possibly due to increased Medicaid coverage in expansion states (from 36.9% to 39.2%) and increased private insurance coverage in nonexpansion states (from 29.5% to 34.7%). There was no significant difference in cancer treatment receipt noted between Medicaid expansion and nonexpansion states. However, the percentage of PLWHC treated at academic facilities increased significantly only in expansion states (from 40.2% to 46.7% P < .0001; difference‐in‐differences analysis: 7.2 percentage points P = .02).
Conclusions
The implementation of the ACA was associated with improved insurance coverage among PLWHC. Lack of insurance still is common in non–Medicaid expansion states. Patients with minority or low socioeconomic status more often resided in nonexpansion states, thereby highlighting the need for further insurance expansion.
The implementation of the Patient Protection and Affordable Care Act (ACA) has been associated with improved insurance coverage among patients living with HIV and cancer. After implementation of the ACA, the percentage of uninsured individuals was reported to be 5 times greater in non–Medicaid expansion states compared with Medicaid expansion states, highlighting the need for further insurance expansion to ensure adequate access to cancer care.
PURPOSE
Differences in the age at diagnosis for lung, colon, breast, and prostate cancers have been reported between low- and middle-income countries (LMICs) and high-income countries (HICs). ...However, this may be influenced by differences in the population age distributions across countries. We aimed to compare the median age at diagnosis for these cancers after adjusting for population age differences.
METHODS
We analyzed data from the Cancer Incidence in 5 Continents (CI5) Volume XI database. It includes information on cancer diagnoses during 2008 to 2012 from cancer registries in 66 countries. We calculated crude median ages at diagnosis for each cancer in each country, and then performed indirect standardization using the age-specific UN world population estimate to remove the influence of population age structure.
RESULTS
Overall, the adjustment for population age structure tended to increase the median ages at diagnosis in LMICs which have younger populations, and decrease them in HICs which have older populations. After standardization, differences between the youngest and oldest median ages of diagnosis across cancer sites were: 11 years for lung cancer (youngest median age observed was 61 in Bulgaria v 71 in Bahrain), 10 years for colon cancer (59 in Iran v 69 New Zealand), 10 years for breast (49 in Algeria v 59 Iceland), and 8 years for prostate cancer (65 in USA v 73 in the Philippines). LMICs had younger ages at diagnosis for colon cancer but older ages at diagnosis for prostate cancer as compared with HICs. Countries with higher smoking prevalence had younger ages at lung cancer diagnosis ( P value Pearson correlation = 0.0025).
CONCLUSION
For lung, colon, breast, and prostate cancers, the differences across countries in the median age at diagnosis range from 8 to 11 years after adjusting for population age distribution. These differences likely reflect population-level variation in risk factors and screening.
The population with HIV is aging and has unique health needs. We present findings from an evaluation of the geriatric-HIV program, Golden Compass, at San Francisco General Hospital. We used the ...implementation science framework, RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to guide the evaluation and used quantitative and qualitative methods to assess RE-AIM dimensions. From January 2017 to June 2018, 198 adults age ≥50 years participated in the program, with an estimated reach of 17%. Providers and patients indicated high acceptability of the program and were satisfied with clinics and classes. Colocation of services, specific pharmacy and geriatric assessments, and social support from classes were valued (effectiveness). Provider adoption was high, and the program was implemented as originally designed. Areas for improvement included challenges of framing aging services to patients. Future efforts will focus on expanding the reach of the program and examining long-term outcomes.
Background: The incidence of papillary thyroid cancer, including advanced-stage and larger tumors, increased markedly in the United States, and obesity is now recognized as an important risk factor. ...We evaluated the extent to which trends in papillary thyroid cancer incidence rates in the United States have been impacted by changes in the prevalence of overweight and obesity. Methods: We used data from the NIH-AARP Diet and Health Study (participants aged ≥50 years) to estimate hazard ratios (HRs) for papillary thyroid cancer (overall and by stage and size of the tumor at diagnosis) by categories of body mass index (BMI), adjusted for demographic (e.g., age, sex, race/ethnicity, education) and other lifestyle-related (alcohol intake, smoking) factors with Cox regression models. Population attributable fractions (PAFs) for overweight/obesity (assuming a 10-year latency period) were calculated using the estimated HRs, overweight/obesity prevalence estimates derived from annual National Health Interview Surveys, and cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER)-13 Program. Results: During follow-up of the NIH-AARP Study, 604 papillary thyroid cancers were identified. Compared to individuals who were normal-weight (18.5-24.9 kg/m
2
), those who were overweight (25.0-29.0 kg/m
2
) or obese (30+ kg/m
2
) experienced a 26% (HR=1.26, 95% CI 1.05-1.53) and 30% (HR=1.30, 95% CI 1.04-1.61) increased risk of papillary thyroid cancer and a nearly 3-fold (HR=2.93, 95% CI 1.25-6.87) and >5-fold (HR=5.42, 95% CI 2.24-13.1) increased risk of large (4+ cm) papillary thyroid cancers. Between 1995 and 2015, the PAF for overweight/obesity increased from 12 to 16% for all papillary thyroid cancers and 52 to 63% for large papillary thyroid cancers. Overweight/obesity accounted for 6% and 37% of the increase in incidence rates for total and large papillary thyroid cancers, respectively. In the absence of overweight/obesity, we would have observed an estimated 0.84, 2.1, and 3.4 fewer papillary thyroid cancers per 100,000 individuals in 1995, 2005, and 2015, respectively. Conclusions: The rising prevalence of overweight and obesity in the United States contributed to the increase in papillary thyroid cancer incidence rates from 1995 to 2015. By 2015, one of every 6 papillary thyroid cancers (and nearly two-thirds of large papillary thyroid cancers) was attributed to overweight or obesity.
IntroductionIncident reports contain descriptions of errors and harms that occurred during clinical care delivery. Few observational studies have characterised incidents from general practice, and ...none of these have been from the England and Wales National Reporting and Learning System. This study aims to describe incidents reported from a general practice care setting.Methods and analysisA general practice patient safety incident classification will be developed to characterise patient safety incidents. A weighted-random sample of 12 500 incidents describing no harm, low harm and moderate harm of patients, and all incidents describing severe harm and death of patients will be classified. Insights from exploratory descriptive statistics and thematic analysis will be combined to identify priority areas for future interventions.Ethics and disseminationThe need for ethical approval was waivered by the Aneurin Bevan University Health Board research risk review committee given the anonymised nature of data (ABHB R&D Ref number: SA/410/13). The authors will submit the results of the study to relevant journals and undertake national and international oral presentations to researchers, clinicians and policymakers.
IntroductionDiesel engine exhaust (DEE) is a known lung carcinogen in humans (IARC Group 1). However, the biological mechanism underlying this association is unclear. Given the suspected relationship ...between inflammation and lung carcinogenesis, we evaluated associations between DEE exposure and a multiplex panel of immune markers in workers exposed to DEE and unexposed workers in China.MethodsA cross-sectional molecular epidemiology study was conducted among 54 workers exposed to DEE in a diesel engine testing facility, and 55 unexposed workers who were employed in separate factories. Repeated personal exposure measurements of elemental carbon (EC) were taken from workers before blood collection. Serum levels of immune markers were analysed using a Luminex bead-based assay. Linear regression was used to evaluate differences in marker concentrations between DEE exposed vs. unexposed workers, and to explore exposure-response trends with EC.ResultsFour markers were significantly associated with DEE exposure in analyses of exposed vs. unexposed workers (P-value < 0.05). Significant monotonic trends in relation to increasing EC levels were observed for CXCL-11/I-TAC (19% reduction in exposed workers overall) and CCL15/MIP-1D (21% increase in exposed workers overall). Analyses of DEE exposed vs. unexposed workers stratified by smoking status found that an additional marker (CCL2/MCP-1) was significantly increased in workers exposed to DEE among never and former smokers, but not current smokers (Pinteraction = 0.01).ConclusionsRecent evidence suggests that higher levels of CCL15/MIP-1D and CCL2/MCP-1, two markers in the CC chemokine subfamily that attract white blood cells to sites of inflammation, are associated with increased risk of lung cancer in Asian never-smoking women. Alterations in these markers in the same direction among workers exposed to DEE in our study may provide mechanistic insight into the relationship between DEE and lung carcinogenesis.
Objectives There is a well-established connection between immune status and carcinogenesis, as an increased risk of cancer has been associated with a history of immunosuppressive medication use, with ...certain chronic infections such as HIV, and with certain autoimmune diseases and lifestyle factors which result in chronic immune alterations and abnormalities. Furthermore, more subtle changes in immune functioning, including imbalances in Th1/Th2 responses resulting from cytokine alterations, have been implicated in the oncogenic process via regulation of transcriptional factors and of tumor growth, angiogenesis, and cell differentiation and survival. Occupational exposures such as trichloroethylene (TCE) are hypothesized to increase cancer risk partly through immunological mechanisms. Characterizing the relationship between occupational chemical exposures and various immune markers could provide important insights into the link between occupational exposures, immunological responses to such exposures and subsequent cancer risk. Method We previously have shown that occupational exposure to trichloroethylene and formaldehyde are associated with hematotoxic effects. Here, we compare the chemical-specific patterns of subsets of CD4 and CD8 cells and other immune-related markers from studies of factory workers exposed to these chemicals. Results The complete blood cell count, lymphocyte subsets, and other immune markers from molecular epidemiology studies of occupational exposure to TCE and formaldehyde will be presented to evaluate the effect of these chemical exposures on immune marker concentrations. Conclusions Our findings suggest that TCE and formaldehyde exposure can alter levels of immunologically active compounds and cell types in different patterns.
Carotenoids are thought to have anti-cancer properties, but findings from population-based research have been inconsistent.
We aimed to conduct a systematic review of the associations between ...carotenoids and lung cancer.
We searched electronic databases for articles published through September 2007. Six randomized clinical trials examining the efficacy of β-carotene supplements and 25 prospective observational studies assessing the associations between carotenoids and lung cancer were analyzed by using random-effects meta-analysis.
The pooled relative risk (RR) for the studies comparing β-carotene supplements with placebo was 1.10 (95% confidence limits: 0.89, 1.36; P = 0.39). Among the observational studies that adjusted for smoking, the pooled RRs comparing highest and lowest categories of total carotenoid intake and of total carotenoid serum concentrations were 0.79 (0.71, 0.87; P < 0.001) and 0.70 (0.44, 1.11; P = 0.14), respectively. For β-carotene, highest compared with lowest pooled RRs were 0.92 (0.83, 1.01; P = 0.09) for dietary intake and 0.84 (0.66, 1.07; P = 0.15) for serum concentrations. For other carotenoids, the RRs comparing highest and lowest categories of intake ranged from 0.80 for β-cryptoxanthin to 0.89 for α-carotene and lutein-zeaxanthin; for serum concentrations, the RRs ranged from 0.71 for lycopene to 0.95 for lutein-zeaxanthin.
β-Carotene supplementation is not associated with a decrease in the risk of developing lung cancer. Findings from prospective cohort studies suggest inverse associations between carotenoids and lung cancer; however, the decreases in risk are generally small and not statistically significant. These inverse associations may be the result of carotenoid measurements’ function as a marker of a healthier lifestyle (higher fruit and vegetable consumption) or of residual confounding by smoking.
Background. Highly Active Antiretroviral Therapy (HAART) has been shown to reduce the incidence of specific AIDS-defining events, including cancers. However, HIV-infected individuals may also have a ...higher incidence of non-AIDS cancers. Objectives. The goals of this dissertation were to (1) estimate the effect of HAART on AIDS-defining cancers relative to other AIDS-defining events, (2) estimate summary standardized incidence ratios (SIRs) for non-AIDS cancers among HIV+ individuals, (3) examine the modification of the association between smoking and smoking-associated cancer risk by HIV, and (4) estimate the association between HIV and lung cancer survival. Methods. Data from the Multicenter AIDS Cohort Study, Tri-service AIDS Clinical Consortium and the AIDS Link to Intravenous Experience studies were used for these analyses. We analyzed the data with (1) Poisson regression models extended to handle events as competing risks; (2) meta-analysis and meta-regression (3) pooled logistic regression and (4) Cox proportional hazards regression. Results. HAART was as effective at preventing both AIDS-defining cancers and other AIDS-defining events (interaction ratio=0.95 (95% confidence interval (CI): 0.51-1.74). Compared to the general population, the incidence of non-AIDS cancers was greater among those with HIV. In particular, cancers associated with infections, such as anal (SIR=26; 95% CI 20-34), liver (SIR=5.4; 95% CI 3.8-7.7) and Hodgkin lymphoma (SIR=11; 95% CI 8.2-14), and cancers associated with cigarette smoking, such as lung (SIR=2.5; 95% CI 2.0-3.1), kidney (SIR=1.7; 95% CI 1.3-2.3) and leukemia (SIR=2.7; 95% CI 2.0-3.8) were observed to be elevated. The association between pack-years smoked and smoking-associated cancers was similar for HIV- and HIV+ participants (P interaction=0.84). Finally, HIV appeared to be associated with poorer survival among lung cancer cases (hazard ratio=3.28; 95% CI 0.86-12.5). Conclusions. HAART appears to be equally effective at preventing both AIDS-defining cancers and other AIDS-defining events. However, those with HIV appear to be at an increased risk for non-AIDS cancers, particularly those associated with infections and smoking. HIV is associated with smoking-associated cancers, however; it does not appear to modify the association between smoking and smoking-associated cancers. Finally, HIV+ lung cancer cases have a significantly shorter survival than those without HIV, perhaps indicating more aggressive cancers.
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