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Zhao J, Dong Y, Clark E, Garcia JM, White DL, Kramer JR, Mazul AL, Hartman C, Chiao EY. Risk and predictors of penile cancer in US Veterans with HIV. AIDS 2024; 38:1395-1401. [PMID: 38652491 DOI: 10.1097/qad.0000000000003914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES People with HIV (PWH) may have an increased burden of penile cancer. We aimed to evaluate the risk of penile cancer in PWH compared with that of the general population. DESIGN We conducted a nationwide retrospective matched cohort study of penile cancer incidence among veterans with HIV (VWH) compared with veterans without HIV. METHODS We compared penile cancer incidence rates in 44 173 VWH to those of veterans without HIV ( N = 159 443; 4 : 1 matched in age). We used Cox regression models to estimate hazard ratios and 95% confidence intervals (CIs) for associations with HIV infection and for penile cancer risk factors. RESULTS HIV positivity was associated with an increased risk of penile cancer, with adjusted hazard ratios of 2.63 (95% CI 1.64-4.23) when adjusting for age, race/ethnicity, baseline BMI, smoking and alcohol use, economic means test, and history of condyloma. The risk increased to hazard ratio = 4.25 (95% CI 2.75-6.57) when adjusting for all factors except history of condyloma. Risk factors for penile cancer in VWH included lower nadir CD4 + count, less than 50% of follow-up time with undetectable HIV viral load, and history of condyloma. CONCLUSION VWH - particularly those with low CD4 + counts, detectable HIV viral loads, or history of condyloma - are at increased risk of penile cancer, suggesting the penile cancer prevention activities are needed in this population.
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Affiliation(s)
- Jing Zhao
- Section of Epidemiology and Population Sciences, Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Yongquan Dong
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)
- Section of Health Services Research, Department of Medicine
| | - Eva Clark
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jose M Garcia
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Healthcare System and Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Donna L White
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)
- Section of Health Services Research, Department of Medicine
- Dan L. Duncan Cancer Center, Baylor College of Medicine
- Texas Medical Center Digestive Disease Center, Baylor College of Medicine, Houston, TX
| | - Jennifer R Kramer
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)
- Section of Health Services Research, Department of Medicine
- Dan L. Duncan Cancer Center, Baylor College of Medicine
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University
- Division of Public Health Science, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Christine Hartman
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)
| | - Elizabeth Y Chiao
- Division of Cancer Prevention and Population Sciences, Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Stem J, Hewitt AJ, Yang Q, Sanger CB. Commonly Drawn Immunologic and Inflammatory Markers as Risk Predictors for Anal Cancer in Veterans Living With HIV. J Low Genit Tract Dis 2024; 28:300-304. [PMID: 38661377 PMCID: PMC11213675 DOI: 10.1097/lgt.0000000000000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This study aimed to determine if immune inflammatory markers (neutrophil lymphocyte ratio [NLR], platelet lymphocyte ratio [PLR], and prognostic nutritional index [PNI]) correlate with anal cancer risk in people living with HIV and to compare these markers with the CD4/CD8 ratio. MATERIALS AND METHODS This is a regional retrospective cohort study of veterans living with HIV who were screened for or diagnosed with anal neoplasia or cancer from 2001 to 2019. The NLR, PLR, PNI, and CD4/CD8 ratio within 1 year of anal pathology results were computed. Patients with anal cancer were compared to patients without anal cancer. Regression modeling was used to estimate the odds of developing anal cancer. RESULTS Three hundred thirty-four patients were included (37 with anal cancer, 297 without anal cancer). In patients with anal cancer, NLR and PLR were higher (2.17 vs 1.69, p = .04; 140 vs 110, p = .02, respectively), while PNI and CD4/CD8 ratio were lower (44.65 vs 50.01, p < .001; 0.35 vs 0.80, p < .001, respectively). On multivariate logistic regression modeling, only PNI (odds ratio, 0.90; p = .001) and CD4/CD8 ratio (odds ratio, 0.05; p < .001) were associated with increased anal cancer risk. CONCLUSIONS Although NLR and PLR independently correlate with anal cancer risk, when controlling for other risk predictors, only PNI and CD4/CD8 ratio were statistically significant biomarkers for anal cancer. The CD4/CD8 ratio is the strongest immune inflammatory marker that predicts risk of anal cancer among veterans living with HIV.
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Affiliation(s)
- Jonathan Stem
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Austin J. Hewitt
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Qiuyu Yang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Cristina B. Sanger
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Surgery, William S. Middleton Memorial Veteran’s Hospital, Madison, WI, USA
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Sheinfil AZ, Day G, Walder A, Hogan J, Giordano TP, Lindsay J, Ecker A. Rural Veterans with HIV and Alcohol Use Disorder receive less video telehealth than urban Veterans. J Rural Health 2024; 40:419-429. [PMID: 37759376 PMCID: PMC10965503 DOI: 10.1111/jrh.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Alcohol use disorder (AUD) is highly prevalent among Veterans with HIV. Rural Veterans with HIV are at especially high risk for not receiving appropriate treatment. This retrospective cohort cross-sectional study aimed to investigate patterns of mental health treatment utilization across delivery modality among Veterans diagnosed with HIV and AUD. It was hypothesized that rural Veterans with HIV and AUD would receive a lower rate of mental health treatment delivered via video telehealth than urban Veterans with HIV and AUD. METHODS A national Veterans Health Association administrative database was used to identify a cohort of Veterans diagnosed with HIV and AUD (N = 2,075). Geocoding was used to categorize rural Veterans (n = 246) and urban Veterans (n = 1,829). Negative binomial regression models tested associations between rurality and mental health treatment delivered via face-to-face, audio-only, and video telehealth modalities. FINDINGS Results demonstrated that rural Veterans with HIV and AUD received fewer mental health treatment sessions delivered via telehealth than urban Veterans with HIV and AUD (incidence rate ratio = 0.62; 95% confidence intervals [0.44, 0.87]; P < .01). No differences were found in terms of treatment delivered face-to-face or by audio-only. CONCLUSIONS Rural Veterans with HIV and AUD represent a vulnerable subpopulation of Veterans who may most benefit from video telehealth. Efforts to increase access and improve the uptake of evidence-based mental health treatment delivered via video telehealth are needed.
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Affiliation(s)
- Alan Z Sheinfil
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Giselle Day
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Annette Walder
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Julianna Hogan
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas P. Giordano
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jan Lindsay
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Rice University’s Baker Institute for Public Policy, Houston, Texas, USA
| | - Anthony Ecker
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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Jiang K, Cao T. Automated HIV Case Identification from the MIMIC-IV Database. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2024; 2024:555-564. [PMID: 38827090 PMCID: PMC11141847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Automatic HIV phenotyping is needed for HIV research based on electronic health records (EHRs). MIMIC-IV, an extension of MIMIC-III, contains more than 520,000 hospital admissions and has become a valuable EHR database for secondary medical research. However, there was no prior phenotyping algorithm to extract HIV cases from MIMIC-IV, which requires a comprehensive knowledge of the database. Moreover, previous HIV phenotyping algorithms did not consider the new HIV-1/HIV-2 antibody differentiation immunoassay tests that MIMIC-IV contains. Our work provided insight into the structure and data elements in MIMIC-IV and proposed a new HIV phenotyping algorithm to fill in these gaps. The results included MIMIC-IV's data tables and elements used, 1,781 and 1,843 HIV cases from MIMIC-IV's versions 0.4 and 2.1, respectively, and summary statistics of these two HIV case cohorts. They could be used for the development of statistical and machine learning models in future studies about the disease.
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Affiliation(s)
- Kai Jiang
- The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States
| | - Tru Cao
- The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States
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Pocobelli G, Oliver M, Albertson-Junkans L, Gundersen G, Kamineni A. Validation of human immunodeficiency virus diagnosis codes among women enrollees of a U.S. health plan. BMC Health Serv Res 2024; 24:234. [PMID: 38389066 PMCID: PMC10885525 DOI: 10.1186/s12913-024-10685-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Efficiently identifying patients with human immunodeficiency virus (HIV) using administrative health care data (e.g., claims) can facilitate research on their quality of care and health outcomes. No prior study has validated the use of only ICD-10-CM HIV diagnosis codes to identify patients with HIV. METHODS We validated HIV diagnosis codes among women enrolled in a large U.S. integrated health care system during 2010-2020. We examined HIV diagnosis code-based algorithms that varied by type, frequency, and timing of the codes in patients' claims data. We calculated the positive predictive values (PPVs) and 95% confidence intervals (CIs) of the algorithms using a medical record-confirmed diagnosis of HIV as the gold standard. RESULTS A total of 272 women with ≥ 1 HIV diagnosis code in the administrative claims data were identified and medical records were reviewed for all 272 women. The PPV of an algorithm classifying women as having HIV as of the first HIV diagnosis code during the observation period was 80.5% (95% CI: 75.4-84.8%), and it was 93.9% (95% CI: 90.0-96.3%) as of the second. Little additional increase in PPV was observed when a third code was required. The PPV of an algorithm based on ICD-10-CM-era codes was similar to one based on ICD-9-CM-era codes. CONCLUSION If the accuracy measure of greatest interest is PPV, our findings suggest that use of ≥ 2 HIV diagnosis codes to identify patients with HIV may perform well. However, health care coding practices may vary across settings, which may impact generalizability of our results.
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Affiliation(s)
- Gaia Pocobelli
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, 98101, Seattle, Washington, USA.
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, 98101, Seattle, Washington, USA
| | - Ladia Albertson-Junkans
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, 98101, Seattle, Washington, USA
| | - Gabrielle Gundersen
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, 98101, Seattle, Washington, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, 98101, Seattle, Washington, USA
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McCann NC, Davenport MJ, Mandavia AD, Stein MD, Livingston NA. HIV Prevalence and HIV Screening History Among a Veterans Association Cohort of People with Opioid and Alcohol Use Disorders. J Gen Intern Med 2024; 39:403-410. [PMID: 37848765 PMCID: PMC10897116 DOI: 10.1007/s11606-023-08452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Veterans face high risk for HIV and substance use, and thus could be disproportionately impacted by the HIV and substance use disorder (SUD) "syndemic." HIV prevalence among veterans with SUD is unknown. OBJECTIVE To project HIV prevalence and lifetime HIV screening history among US veterans with alcohol use disorder (AUD), opioid use disorder (OUD), or both. DESIGN We conducted a retrospective cohort analysis using national Veterans Health Administration (VHA) data. PARTICIPANTS We selected three cohorts of veterans with SUD: (1) AUD, (2) OUD, and (3) AUD/OUD. Included veterans had ICD codes for AUD/OUD from 2016 to 2022 recorded in VHA electronic medical records, sourced from the VA Corporate Data Warehouse (CDW). MAIN MEASURES We estimated HIV prevalence by dividing the number of veterans who met two out of three criteria (codes for HIV diagnosis, antiretroviral therapy, or HIV screening/monitoring) by the total number of veterans in each cohort. We also estimated lifetime HIV screening history (as documented in VHA data) by cohort. We reported HIV prevalence and screening history by cohort and across demographic/clinical subgroups. KEY RESULTS Our sample included 669,595 veterans with AUD, 63,787 with OUD, and 57,015 with AUD/OUD. HIV prevalence was highest in the AUD/OUD cohort (3.9%), followed by the OUD (2.1%) and AUD (1.1%) cohorts. Veterans of Black race and Hispanic/Latinx ethnicity, with HCV diagnoses, and aged 50-64 had the highest HIV prevalence in all cohorts. Overall, 12.8%, 29.1%, and 33.1% of the AUD/OUD, OUD, and AUD cohorts did not have history of HIV screening, respectively. CONCLUSIONS HIV prevalence was high in all SUD cohorts, and was highest among veterans with AUD/OUD, with disparities by race/ethnicity and age. A substantial portion of veterans had not received HIV screening in the VHA. Findings highlight room for improvement in HIV prevention and screening services for veterans with SUD.
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Affiliation(s)
- Nicole C McCann
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Michael J Davenport
- Data Science Core, Boston CSPCC, VA Boston Healthcare System, Boston, MA, USA
| | - Amar D Mandavia
- Medical Informatics, VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael D Stein
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Nicholas A Livingston
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- National Center for PTSD, Behavioral Science Division, VA Boston Health Care System, Boston, MA, USA.
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Sada YH, da Costa WL, Kramer JR, Chiao EY, Zafeiropoulou E, Dong Y, Chen L, Dang BN. Survival outcomes in veterans with hepatocellular carcinoma, with and without HIV infection. AIDS 2023; 37:1387-1397. [PMID: 37070557 DOI: 10.1097/qad.0000000000003568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND HIV infection has been associated with survival disparities among persons with hepatocellular carcinoma (HCC). However, most studies examining survival do not control for provider (e.g. type of HCC treatment given) or individual-level factors (e.g. homelessness, substance use) that could impact survival. In this study, we evaluate the effect of HIV status on survival among persons with HCC, in a comprehensive model that accounts for key individual, provider, and systems-level factors. METHODS We conducted a retrospective cohort study of persons with HIV (PWH) matched 1 : 1 to HIV-negative controls based on age and year of HCC diagnosis in the national Veterans Administration (VA) health system. The primary outcome was survival. We used Cox regression models to evaluate the effect of HIV status on risk of death. RESULTS This cohort included 200 matched pairs diagnosed with HCC between 2009 and 2016. A total of 114 PWH (57.0%) and 115 HIV-negative patients (57.5%) received guideline-concordant therapy ( P = 0.92). Median survival was 13.4 months [95% confidence interval (CI) 8.7-18.1] among PWH and 19.1 months (95% CI 14.6-24.9) for HIV-negative patients. In adjusted models, older age, homelessness, advanced Barcelona Clinic Liver Cancer (BCLC) stage, and not receiving any HCC treatment predicted risk of death. HIV status was not associated with risk of death [adjusted hazard ratio (aHR) 0.95; 95% CI 0.75-1.20; P = 0.65]. CONCLUSION HIV status was not associated with worse survival among HCC patients, in a single-payer, equal access healthcare system. These results suggest that HIV infection alone should not exclude PWH from receiving standard therapy.
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Affiliation(s)
- Yvonne H Sada
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center
- Section of Hematology, Department of Medicine
- Dan L Duncan Comprehensive Cancer Center
| | - Wilson L da Costa
- Dan L Duncan Comprehensive Cancer Center
- Section of Epidemiology and Population Sciences
| | - Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine
| | - Elizabeth Y Chiao
- Dan L Duncan Comprehensive Cancer Center
- Department of Epidemiology, Cancer Prevention and Population Sciences
- Department of General Oncology, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center
| | - Efthalia Zafeiropoulou
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center
| | - Yongquan Dong
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center
| | - Liang Chen
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center
| | - Bich N Dang
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Oluyomi AO, Mazul AL, Dong Y, White DL, Hartman CM, Richardson P, Chan W, Garcia JM, Kramer JR, Chiao E. Area deprivation index and segregation on the risk of HIV: a U.S. Veteran case-control study. LANCET REGIONAL HEALTH. AMERICAS 2023; 20:100468. [PMID: 36992707 PMCID: PMC10041556 DOI: 10.1016/j.lana.2023.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/31/2023]
Abstract
Background Preventing HIV infection remains a critically important tool in the continuing fight against HIV/AIDS. The primary aim is to evaluate the effect and interactions between a composite area-level social determinants of health measure and an area-level measure of residential segregation on the risk of HIV/AIDS in U.S. Veterans. Methods Using the individual-level patient data from the U.S. Department of Veterans Affairs, we constructed a case-control study of veterans living with HIV/AIDS (VLWH) and age-, sex assigned at birth- and index date-matched controls. We geocoded patient's residential address to ascertain their neighborhood and linked their information to two measures of neighborhood-level disadvantage: area deprivation index (ADI) and isolation index (ISOL). We used logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) for comparing VLWH with matched controls. We performed analyses for the entire U.S. and separately for each U.S. Census division. Findings Overall, living in minority-segregated neighborhoods was associated with a higher risk of HIV (OR: 1.88 (95% CI: 1.79-1.97) while living in higher ADI neighborhoods was associated with a lower risk of HIV (OR: 0.88; 95% CI: 0.84-0.92). The association between living in a higher ADI neighborhood and HIV was inconsistent across divisions, while living in minority-segregated neighborhoods was consistently associated with increased risk across all divisions. In the interaction model, individuals from low ADI and high ISOL neighborhoods had a higher risk of HIV in three divisions: East South Central; West South Central, and Pacific. Interpretation Our results suggest that residential segregation may prevent people in disadvantaged neighborhoods from protecting themselves from HIV independent from access to health care. There is the need to advance knowledge about the neighborhood-level social-structural factors that influence HIV vulnerability toward developing interventions needed to achieve the goal of ending the HIV epidemic. Funding US National Cancer Institute.
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Affiliation(s)
- Abiodun O. Oluyomi
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Angela L. Mazul
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Yongquan Dong
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Donna L. White
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Center for Translational Research in Inflammatory Disease (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Christine M. Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Peter Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, USA
| | - Jose M. Garcia
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System and Div. of Geriatrics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer R. Kramer
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Elizabeth Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Corresponding author. Epidemiology Department, T 713-792-3020 F 713-563-1367, Unit 1340, 1155 Pressler, Duncan Building (CPB), 4th Floor, D 713-792-1860 C 713-303-1978, USA.
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Abbara S, Guillemot D, El Oualydy S, Kos M, Poret C, Breant S, Brun-Buisson C, Watier L. Antimicrobial Resistance and Mortality in Hospitalized Patients with Bacteremia in the Greater Paris Area from 2016 to 2019. Clin Epidemiol 2022; 14:1547-1560. [PMID: 36540898 PMCID: PMC9759973 DOI: 10.2147/clep.s385555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/12/2022] [Indexed: 08/15/2023] Open
Abstract
PURPOSE Antibiotic-resistant bacteremia is a leading global cause of infectious disease morbidity and mortality. Clinical data warehouses (CDWs) allow for the secure, real-time coupling of diverse data sources from real-world clinical settings, including care-based medical-administrative data and laboratory-based microbiological data. The main purpose of this study was to assess the contribution of CDWs in the epidemiological study of antibiotic resistance by constructing a database of bacteremia patients, BactHub, and describing their main clinico-microbiological features and outcomes. PATIENTS AND METHODS Adult patients with bacteremia hospitalized between January 1, 2016 and December 31, 2019 in 14 acute care university hospitals from the Greater Paris area were identified; their first bacteremia episode was included. Data describing patients, episodes of bacteremia, bacterial isolates, and antimicrobial resistance were structured. RESULTS Among 29,228 patients with bacteremia, 41% of episodes were community-onset (CO) and 59% were hospital-acquired (HA). Thirty-day and ninety-day mortality rates were 15% and 20% in CO episodes, and 18% and 36% in HA episodes. Overall resistance rates were high, including third-generation cephalosporin resistance among Klebsiella pneumoniae (CO 21%, HA 37%) and Escherichia coli (CO 13%, HA 17%), and methicillin resistance among Staphylococcus aureus (CO 11%, HA 14%). Annual incidence rates increased significantly from 2017 to 2019, from 20.0 to 20.9 to 22.1 stays with bacteremia per 1000 stays (p < 0.0001). CONCLUSION The Bacthub database provides accurate clinico-microbiological data describing bacteremia across France's largest hospital group. Data from Bacthub may inform surveillance and the clinical decision-making process for bacteremia patients, including choice of antimicrobial therapy. The database also offers opportunities for research, including analysis of hospital care pathways and significant patient outcomes such as mortality and recurrence of infection.
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Affiliation(s)
- Salam Abbara
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, Montigny-Le-Bretonneux, France
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), University Paris Cité, Paris, France
| | - Didier Guillemot
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, Montigny-Le-Bretonneux, France
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), University Paris Cité, Paris, France
- Public Health, Medical Information, Clinical Research, AP-HP, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Salma El Oualydy
- Plateforme des données de santé - Health Data Hub, Paris, France
| | - Maeva Kos
- Plateforme des données de santé - Health Data Hub, Paris, France
| | - Cécile Poret
- AP-HP, Direction des Systèmes d’Information, Pôle Innovation et Données, Paris, France
| | - Stéphane Breant
- AP-HP, Direction des Systèmes d’Information, Pôle Innovation et Données, Paris, France
| | - Christian Brun-Buisson
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, Montigny-Le-Bretonneux, France
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), University Paris Cité, Paris, France
| | - Laurence Watier
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, Montigny-Le-Bretonneux, France
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), University Paris Cité, Paris, France
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10
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Mazul AL, Hartman CM, Mowery YM, Kramer JR, White DL, Royse KE, Raychaudhury S, Sandulache VC, Ahmed ST, Zevallos JP, Richardson PA, Sikora AG, Chiao EY. Risk and incidence of head and neck cancers in veterans living with HIV and matched HIV-negative veterans. Cancer 2022; 128:3310-3318. [PMID: 35867552 PMCID: PMC10650941 DOI: 10.1002/cncr.34387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Persons living with HIV/AIDS have a higher incidence of virus-related and tobacco/alcohol-related cancers. This study is the first to estimate the effect of HIV versus HIV-negative veterans on the risk of head and neck squamous cell carcinoma incidence in a large retrospective cohort study. METHODS The authors constructed a retrospective cohort study using patient data from 1999 to 2016 from the National Veterans Administration Corporate Data Warehouse and the VA Central Cancer Registry. This cohort study included 45,052 veterans living with HIV/AIDS and 162,486 HIV-negative patients matched by age, sex, and index visit (i.e., HIV diagnosis date or clinic visit date). The age-standardized incidence rates and estimated adjusted hazard ratios were calculated with a Cox proportional hazards regression for oropharyngeal and nonoropharyngeal head and neck cancer squamous cell carcinoma (HNSCC). The authors also abstracted human papillomavirus (HPV) status from oropharyngeal HNSCC diagnosed after 2010. RESULTS Veterans living with HIV/AIDS (VLWH) have 1.71 (95% confidence interval [CI], 1.36, 2.14) times the risk of oropharyngeal cancer and 2.06 (95% CI, 1.76, 2.42) times the hazard of nonoropharyngeal cancer compared with HIV-negative veterans. VLWH with oropharyngeal squamous cell carcinoma (OPSCC) were more likely to be HPV-positive (N = 30 [81.1%]) than the HIV-negative veterans with OPSCC (N = 50 [67.6%]), although this difference was not significant (p = .135). For nonoropharyngeal cancer, the increased risk of oral cavity cancer among VLWH drove the increased risk. CONCLUSIONS The study results suggest that HIV may play a role in virally mediated and nonvirally mediated HNSCC. As the HIV prevalence rises in the United States due to better survival and the incidence of HPV-positive oropharyngeal HNSCC increases, the interaction between HPV and HIV becomes increasingly relevant.
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Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Division of Public Health Science, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christine M Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Yvonne M Mowery
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer R Kramer
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Donna L White
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kathryn E Royse
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Vlad C Sandulache
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Sarah T Ahmed
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jose P Zevallos
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Peter A Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Andrew G Sikora
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Y Chiao
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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May SB, Giordano TP, Gottlieb A. A Phenotyping Algorithm to Identify People With HIV in Electronic Health Record Data (HIV-Phen): Development and Evaluation Study. JMIR Form Res 2021; 5:e28620. [PMID: 34842532 PMCID: PMC8727048 DOI: 10.2196/28620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/10/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background Identification of people with HIV from electronic health record (EHR) data is an essential first step in the study of important HIV outcomes, such as risk assessment. This task has been historically performed via manual chart review, but the increased availability of large clinical data sets has led to the emergence of phenotyping algorithms to automate this process. Existing algorithms for identifying people with HIV rely on a combination of International Classification of Disease codes and laboratory tests or closely mimic clinical testing guidelines for HIV diagnosis. However, we found that existing algorithms in the literature missed a significant proportion of people with HIV in our data. Objective The aim of this study is to develop and evaluate HIV-Phen, an updated criteria-based HIV phenotyping algorithm. Methods We developed an algorithm using HIV-specific laboratory tests and medications and compared it with previously published algorithms in national and local data sets to identify cohorts of people with HIV. Cohort demographics were compared with those reported in the national and local surveillance data. Chart reviews were performed on a subsample of patients from the local database to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the algorithm. Results Our new algorithm identified substantially more people with HIV in both national (up to an 85.75% increase) and local (up to an 83.20% increase) EHR databases than the previously published algorithms. The demographic characteristics of people with HIV identified using our algorithm were similar to those reported in national and local HIV surveillance data. Our algorithm demonstrated improved sensitivity over existing algorithms (98% vs 56%-92%) while maintaining a similar overall accuracy (96% vs 80%-96%). Conclusions We developed and evaluated an updated criteria-based phenotyping algorithm for identifying people with HIV in EHR data that demonstrates improved sensitivity over existing algorithms.
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Affiliation(s)
- Sarah B May
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.,Center for Innovation in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, United States
| | - Thomas P Giordano
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.,Center for Innovation in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, United States.,Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Assaf Gottlieb
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
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12
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Yoder AK, Lakomy DS, Dong Y, Raychaudhury S, Royse K, Hartman C, Richardson P, White DL, Kramer JR, Lin LL, Chiao E. The association between protease inhibitors and anal cancer outcomes in veterans living with HIV treated with definitive chemoradiation: a retrospective study. BMC Cancer 2021; 21:776. [PMID: 34225709 PMCID: PMC8256603 DOI: 10.1186/s12885-021-08514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The incidence of anal squamous cell carcinoma has been increasing, particularly in people living with HIV (PLWH). There is concern that radiosensitizing drugs, such as protease inhibitors, commonly used in the management of HIV, may increase toxicities in patients undergoing chemoradiation. This study examines treatment outcomes and toxicities in PLWH managed with and without protease inhibitors who are receiving chemoradiation for anal cancer. METHODS Patient demographic, HIV management, and cancer treatment information were extracted from multiple Veterans Affairs databases. Patients were also manually chart reviewed. Among PLWH undergoing chemoradiation for anal carcinoma, therapy outcomes and toxicities were compared between those treated with and without protease inhibitors at time of cancer treatment. Statistical analysis was performed using chi-square, Cox regression analysis, and logistic regression. RESULTS A total of 219 PLWH taking anti-retroviral therapy undergoing chemoradiation for anal cancer were identified and included in the final analysis. The use of protease inhibitors was not associated with any survival outcome including colostomy-free survival, progression-free survival, or overall survival (all adjusted hazard ratio p-values> 0.05). Regarding toxicity, protease inhibitor use was not associated with an increased odds of hospitalizations or non-hematologic toxicities; however, protease inhibitor use was associated with increased hospitalizations for hematologic toxicities, including febrile neutropenia (p < 0.01). CONCLUSION The use of protease inhibitors during chemoradiation for anal carcinoma was not associated with any clinical outcome or increase in non-hematologic toxicity. Their use was associated with increased hospitalizations for hematologic toxicities. Further prospective research is needed to evaluate the safety and efficacy of protease inhibitors for patients undergoing chemoradiation.
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Affiliation(s)
- Alison K Yoder
- University of Texas Health Science Center at Houston, McGovern School of Medicine, Houston, TX, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David S Lakomy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - Yongquan Dong
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Suchismita Raychaudhury
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Kathryn Royse
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
| | - Christine Hartman
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Peter Richardson
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Donna L White
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jennifer R Kramer
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lilie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Chiao
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA.
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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13
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Sanger CB, Xu Y, Carchman E, Lawson E, Heise C, Striker R, Voils CI. Prevalence of High-Grade Anal Dysplasia and Anal Cancer in Veterans Living With HIV and CD4/CD8 Ratio as a Marker For Increased Risk: A Regional Retrospective Cohort Study. Dis Colon Rectum 2021; 64:805-811. [PMID: 34086000 PMCID: PMC8186795 DOI: 10.1097/dcr.0000000000002009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Department of Veterans Affairs cares for the largest population of patients with HIV of any healthcare system in the United States. Screening for anal dysplasia/cancer is recommended for all veterans with HIV. Exams are invasive, burdensome, and resource intensive. We currently lack markers of disease to tailor screening. OBJECTIVE The purpose of this study was to establish the prevalence of advanced anal disease (high-grade dysplasia and anal cancer) and to determine whether CD4/CD8 ratio correlates with risk. DESIGN This was a retrospective regional cohort study of veterans with HIV. SETTINGS The study was conducted at eight medical centers between 2001 and 2019. PATIENTS Patients with advanced disease were compared with patients with nonadvanced anal pathology. MAIN OUTCOME MEASURES Logistic regression modeling was used to estimate adjusted odds of disease as a function of CD4/CD8. Lowest (nadir) CD4/CD8 and nearest CD4/CD8 ratio in each cohort were evaluated. RESULTS A total of 2267 veterans were included. Fifteen percent had anal pathology (112 with advanced disease (37 cancer and 75 high-grade), 222 with nonadvanced disease). Nadir and nearest ratio were lower in patients with advanced disease versus nonadvanced (0.24 vs 0.45 (p < 0.001) and 0.50 vs 0.88 (p < 0.001)). In adjusted models, a 1-unit increase in nadir or nearest ratio conferred decreased risk of advanced disease (OR = 0.19 (95% CI, 0.07-0.53); p < 0.001; OR = 0.22 (95% CI, 0.12-0.43); p < 0.001). Using a minimum sensitivity analysis, a cutoff nadir ratio of 0.42 or nearest ratio of 0.76 could be used to risk stratify. LIMITATIONS This was a retrospective analysis with a low screening rate. CONCLUSIONS In a regional cohort of veterans with HIV, 15% were formally assessed for anal dysplasia. Advanced anal disease was present in 33% of those screened, 5% of the HIV-positive population. A strong predictor of advanced disease in this cohort is the CD4/CD8 ratio, which is a promising marker to stratify screening practices. Risk stratification using CD4/CD8 has the potential to decrease burdensome invasive examinations for low-risk patients and to intensify examinations for those at high risk. See Video Abstract at http://links.lww.com/DCR/B528. PREVALENCIA DE DISPLASIA ANAL DE ALTO GRADO Y CNCER ANAL EN VETERANOS QUE VIVEN CON EL VIH Y LA RELACIN CD / CD COMO MARCADOR DE MAYOR RIESGO UN ESTUDIO DE COHORTE REGIONAL RETROSPECTIVE ANTECEDENTES:El Departamento de Asuntos de Veteranos atiende a la población más grande de pacientes con el virus de inmunodeficiencia humana (VIH) de cualquier sistema de salud en los Estados Unidos. Se recomienda la detección de displasia / cáncer anal para todos los veteranos con VIH. Los exámenes son invasivos, onerosos y requieren muchos recursos. Actualmente carecemos de marcadores de enfermedad para adaptar la detección.OBJETIVO:Establecer la prevalencia de enfermedad anal avanzada (displasia de alto grado y cáncer anal) y determinar si la relación CD4 / CD8 se correlaciona con el riesgo.DISEÑO:Estudio de cohorte regional retrospectivo de veteranos con VIH.AJUSTE:Ocho centros médicos entre 2001-2019.PACIENTES:Se comparó a pacientes con enfermedad avanzada con pacientes con patología anal no avanzada.PRINCIPALES MEDIDAS DE RESULTADO:Se utilizó un modelo de regresión logística para estimar las probabilidades ajustadas de enfermedad en función de CD4 / CD8. Se evaluó la relación CD4 / CD8 más baja (nadir) y la relación CD4 / CD8 más cercana en cada cohorte.RESULTADOS:Se incluyeron un total de 2267 veteranos. El 15% tenía patología anal (112 enfermedad avanzada (37 cáncer, 75 de alto grado), 222 enfermedad no avanzada). El nadir y el cociente más cercano fueron menores en los pacientes con enfermedad avanzada frente a los no avanzados (0,24 frente a 0,45 (p <0,001) y 0,50 frente a 0,88 (p <0,001)), respectivamente. En modelos ajustados, el aumento de una unidad en el nadir o el cociente más cercano confirió una disminución del riesgo de enfermedad avanzada (OR 0,19 (IC del 95%: 0,07, 0,53, p <0,001)) y (OR 0,22 (IC del 95%: 0,12, 0,43, p <0,001))), respectivamente. Utilizando un análisis de sensibilidad mínima, se podría utilizar un cociente del nadir de corte de 0,42 o el cociente más cercano de 0,76 para estratificar el riesgo.LIMITACIONES:Análisis retrospectivo con una tasa de detección baja.CONCLUSIONES:En una cohorte regional de veteranos con VIH, el 15% fueron evaluados formalmente por displasia anal. La enfermedad anal avanzada estuvo presente en el 33% de los examinados, el 5% de la población VIH +. Un fuerte predictor de enfermedad avanzada en esta cohorte es la relación CD4 / CD8, que es un marcador prometedor para estratificar las prácticas de detección. La estratificación del riesgo usando CD4 / CD8 tiene el potencial de disminuir los exámenes invasivos onerosos para los pacientes de bajo riesgo e intensificar los exámenes para los de alto riesgo. Consulte Video Resumen en http://links.lww.com/DCR/B528.
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Affiliation(s)
- Cristina B. Sanger
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
- William S. Middleton Memorial Veteran’s Hospital, Madison, WI
| | - Yiwei Xu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Evie Carchman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Elise Lawson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Charles Heise
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Rob Striker
- William S. Middleton Memorial Veteran’s Hospital, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Corrine I. Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
- William S. Middleton Memorial Veteran’s Hospital, Madison, WI
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14
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Clark E, Chen L, Dong Y, Raychaudhury S, White D, Kramer JR, Chiao E. Veteran Women Living With Human Immunodeficiency Virus Have Increased Risk of Human Papillomavirus (HPV)-Associated Genital Tract Cancers. Clin Infect Dis 2021; 72:e359-e366. [PMID: 32785700 DOI: 10.1093/cid/ciaa1162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Disparities in access to screening often confound observed differences in human papillomavirus (HPV)-associated female genital tract cancer (FGTC) incidence between women living with human immunodeficiency virus (HIV; WLWH) and their HIV-negative counterparts. We aimed to determine if there have been changes in cancer risk among WLWH during the antiretroviral era in a single-payer health system. METHODS We retrospectively selected WLWH and HIV-negative controls receiving care between 1999 and 2016 at the US Department of Veterans Affairs (VA) and identified FGTC diagnoses via Cancer Registry and International Classification of Diseases-9/10 codes. We extracted demographic and clinical variables from the VA's Corporate Data Warehouse; evaluated incidence rates (IRs), incidence rate ratios, hazard ratios, and 95% confidence intervals (CIs) for cancer risk; and conducted survival analyses. RESULTS We identified 1454 WLWH and compared them with 5816 matched HIV-negative controls. More WLWH developed HPV-associated FGTCs (total n = 28 [2.0%]; cervical = 22, vulvovaginal = 4, and anal/rectal = 2) than HIV-negative women (total n = 32 [0.6%]; cervical = 24, vulvovaginal = 5, and anal/rectal = 5) (log rank P < .0001). Cervical cancer IR was >6-fold higher for WLWH (204.2 per 100 000 person-years [py] [95% CI, 83.8-324.7]) than HIV-negative women (IR = 31.2 per 100 000 py [95% CI, 17.9-44.5]). The IRs for vulvovaginal and anal cancers were also higher in WLWH. Overall, WLWH were more likely to develop HPV-associated FGTCs compared with their HIV-negative counterparts (all log rank P values < .0001). CONCLUSIONS Veteran WLWH are more likely to develop HPV-associated FGTCs despite equal access to health care. Even in single-payer health systems, WLWH continue to require special attention to ensure guideline-based high-risk HPV screening for prevention of FGTCs.
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Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.,Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
| | - Liang Chen
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Yongquan Dong
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Suchismita Raychaudhury
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Donna White
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
| | - Jennifer R Kramer
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth Chiao
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.,Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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15
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Rethy LB, Feinstein MJ, Achenbach CJ, Townsend RR, Bress AP, Shah SJ, Cohen JB. Antihypertensive Class and Cardiovascular Outcomes in Patients With HIV and Hypertension. Hypertension 2021; 77:2023-2033. [PMID: 33813847 DOI: 10.1161/hypertensionaha.120.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Leah B Rethy
- Department of Medicine (L.B.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Matthew J Feinstein
- Cardiology Division (M.J.F., S.J.S.), Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Chad J Achenbach
- Infectious Diseases Division (C.J.A.), Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Raymond R Townsend
- Renal-Electrolyte and Hypertension Division (R.R.T., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City (A.P.B.)
| | - Sanjiv J Shah
- Cardiology Division (M.J.F., S.J.S.), Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division (R.R.T., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics (J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (J.B.C.)
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16
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Garcia JM, Kramer JR, Richardson PA, Ahmed S, Royse KE, White DL, Raychaudhury S, Chang E, Hartman CM, Silverberg MJ, Chiao EY. Effect of Body Weight and Other Metabolic Factors on Risk of Non-Small Cell Lung Cancer among Veterans with HIV and a History of Smoking. Cancers (Basel) 2020; 12:cancers12123809. [PMID: 33348663 PMCID: PMC7765814 DOI: 10.3390/cancers12123809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Among people living with HIV (PWH), there has been an increasing incidence of non-small cell lung cancer (NSCLC) and metabolic abnormalities, such as diabetes and high cholesterol, which affect the risk of NSCLC. In this article, we evaluate which metabolic risk factors increase the risk of NSCLC among PWH who smoke. Through a retrospective study that includes 33,351 veterans, we found that the risk of NSCLC was lower in well-controlled PWH (1.46 vs. 2.06/1000 patient/year [PY]). Metabolic factors associated with higher NSCLC risk included lower body weight at HIV diagnosis and a remote history of involuntary weight loss in PWH regardless of whether they had a well-controlled infection or not. Lower HDL and triglyceride levels increased the risk of NSCLC only in non-well-controlled smokers. Our results suggest these factors may be important to consider in targeting surveillance and for early identification of NSCLC in PWH smokers. Abstract Among people living with HIV (PWH), there has been an increasing incidence of non-small cell lung cancer (NSCLC) and metabolic abnormalities, including dyslipidemia, which can modulate NSCLC risk. In this article, we evaluate which metabolic risk factors are associated with incident risk among PWH who smoke. This is done through a retrospective cohort study, using data of HIV+ veterans who smoke from the nationwide Veterans Affairs (VA) healthcare system. Data on diagnostic codes, medication, and laboratory values of 33,351 veterans were obtained using the VA’s Corporate Data Warehouse and Central Cancer Registry. We calculated NSCLC incidence and utilized Cox regression to determine metabolic factors associated with NSCLC risk. HIV+ cohort was 97.4% male; median age = 47 years and 20,050 (60.1%) well-controlled (≥80% follow-up time undetectable viral load). Crude incidence rates were lower in well-controlled PWH (1.46 vs. 2.06/1000 PY). Metabolic factors associated with incident NSCLC risk included lower BMI at HIV diagnosis and cachexia history in both groups, while HDL and triglycerides were significant in non-well-controlled smokers only. Our findings that lower BMI at HIV diagnosis, history of cachexia among individuals with well-controlled HIV, and cachexia presence at diagnosis are associated with increased risk of developing NSCLC in PWH with a history of smoking have important implications.
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Affiliation(s)
- Jose M. Garcia
- Geriatric Research, Education, and Clinical Center, VA Puget Sound HCS, Seattle, WA 98108, USA;
- Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jennifer R. Kramer
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
- Texas Medical Center Digestive Diseases Center, Houston, TX 77030, USA
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Peter A. Richardson
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sarah Ahmed
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kathryn E. Royse
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
| | - Donna L. White
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
- Texas Medical Center Digestive Diseases Center, Houston, TX 77030, USA
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Suchismita Raychaudhury
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elaine Chang
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
| | - Christine M. Hartman
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA;
| | - Elizabeth Y. Chiao
- VA Health Services Research Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (J.R.K.); (P.A.R.); (S.A.); (K.E.R.); (D.L.W.); (S.R.); (E.C.); (C.M.H.)
- Texas Medical Center Digestive Diseases Center, Houston, TX 77030, USA
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-792-1860
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17
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Mazul AL, Hartman C, Kramer J, White DL, Royse K, Raychaudhury S, Sandulache V, Ahmed ST, Richardson P, Sikora AG, Chiao E. Incidence and survival for oropharynx and non-oropharynx head and neck cancers among veterans living with HIV. Cancer Med 2020; 9:9326-9335. [PMID: 33094910 PMCID: PMC7774719 DOI: 10.1002/cam4.3539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/27/2020] [Accepted: 09/28/2020] [Indexed: 01/06/2023] Open
Abstract
Background People living with HIV/AIDS (PLWH) have an excess risk for head and neck squamous cell carcinoma (HNSCC) compared to the general U.S. population, but little is known about HIV‐specific risk factors associated with the incidence and outcomes HNSCC. We aim to identify clinical and HIV‐specific risk factors associated with oropharyngeal and non‐oropharyngeal HNSCC incidence and outcomes separately. Methods We constructed a retrospective cohort study of 45,052 PLWH aged 18 or above from the national Veteran Affairs (VA) Corporate Data from 1999 to 2015. We extracted demographic data and risk factor information, including history of alcohol abuse, smoking, CD4 count (cells/μl), and percent of follow‐up time with undetectable HIV viral load as time‐updated variables. We calculated the age‐standardized incidence rates of oropharyngeal and non‐oropharyngeal HNSCC and estimated adjusted hazard ratios (HR). We also examined overall survival using Kaplan–Meier curves and adjusted HR. Results The standardized incidence rate of oropharyngeal and non‐oropharyngeal HNSCC in this veteran cohort of PLWH is 23.0 (95% confidence intervals (CIs): 17.1‐28.9) and 55.4 (95% CI: 46.5‐64.3) per 100,000 person‐years, respectively. Nadir CD4 count ≤200 was associated with an increased risk of non‐oropharyngeal HNSCC (HR: 1.78; 95% CI: 1.31‐2.30 vs >200). Five‐year overall survival of OPSCC (37.0%) was significantly lower than non‐oropharyngeal HNSCC (49.1%). Conclusions PLWH who receive care in the VA had higher age‐adjusted HNSCC incidence rates than reported in the general population, suggesting that HIV and immunosuppression play a role. Additional studies should be conducted to study the interaction between HPV and HIV.
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Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,Division of Public Health Science, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Christine Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jennifer Kramer
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Donna L White
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn Royse
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Vlad Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sarah T Ahmed
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Peter Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Andrew G Sikora
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Otolaryngology Section, Operative Care Line Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Elizabeth Chiao
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
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