Excess Hospital Use and Years of Life Lost After Cancer Diagnosis among People with HIV: A Nationwide Study in Spain.

BACKGROUND

Cancer is an increasingly important cause of morbidity and mortality among people with HIV (PWH), yet its impact on post-index-admission hospital trajectories remains poorly characterized.

METHODS

We conducted a nationwide study using the mandatory Nationwide Hospital Discharge Database of the Spanish National Health System, including all adult hospital admissions from 1997 to 2023. We compared PWH and individuals without HIV for trends in cancer-related hospitalizations, clinical characteristics, post-index-admission hospital trajectories, healthcare use, in-hospital mortality, and years of life lost (YLL).

RESULTS

Among 115,171,334 admissions, 626,066 occurred in PWH. Cancer-related hospitalizations increased in both groups, but more steeply among PWH, reaching nearly one in five hospitalizations in 2020-2023. At first cancer admission, PWH were younger, had greater comorbidity, and more often had metastatic disease. Following cancer diagnosis, PWH had higher readmission risk, more frequent rehospitalizations, shorter time to readmission, longer cumulative stay, and higher hospitalization costs. A composite measure of complex hospital trajectory was more frequent among PWH (29.6% vs 18.0%; adjusted OR 1.38, 95% CI 1.34-1.41). In-hospital mortality was higher (12.1% vs 8.9%; adjusted OR 1.83, 95% CI 1.79-1.87), and YLL were greater overall (35 vs 18 years) and across major cancer types.

CONCLUSIONS

Cancer has emerged as a major and growing driver of hospitalization among PWH, characterized by sustained excess hospital use, complex post-index-admission hospital trajectories, and significantly greater premature mortality.