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Incidence of AIDS-Related Kaposi Sarcoma in All 50 United States From 2000 to 2014

White, Donna L. PhDa,b,c,d,e; Oluyomi, Abiodun PhD, MSd; Royse, Kathryn PhDb; Dong, Yongquan MSb; Nguyen, Harrison MDb; Chang, Elaine MDb,f; Richardson, Peter PhDb; Jiao, Li PhDa,b,c,d,e; Garcia, Jose M. MDg,h; Kramer, Jennifer R. PhDb,c,d; Thrift, Aaron P. PhDd,i; Chiao, Elizabeth MD, MPHb,c,d,j

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1, 2019 - Volume 81 - Issue 4 - p 387–394
doi: 10.1097/QAI.0000000000002050
Epidemiology
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Background: Although declining rates of incident AIDS-related Kaposi sarcoma (KS) have been reported, KS incidence rates have noted race/ethnic, age, and geographic diversity. We performed a comprehensive assessment of recent secular trends in AIDS-related KS incidence in the United States.

Methods: We identified incident KS diagnosed in men aged 20–54 years (who comprise most AIDS-related KS in the United States) using the US Cancer Statistics registry data. Joinpoint analysis assessed for trends in age-adjusted incidence rates between 2000 and 2014 calculating average annual percentage changes (AAPCs) with 95% confidence intervals. Heat maps were generated to compare age-adjusted HIV incidence rates with KS incidence rates.

Results: Age-adjusted KS incidence rates nationwide decreased from 1.44/100,000 to 0.95/100,000 between 2000 and 2014. Observed rate changes varied across subgroups; eg, there were significant decreases in 30–44 years (AAPC = −5.4%), particularly in Whites and Blacks, significant increases among 20–29 years (AAPC = 2.7), primarily in Blacks, and stable rates among 45–54 years (AAPC = −0.03). In Southern United States, the incidence rates among Blacks did not significantly change. The states with highest average age-adjusted rates over the study period were Georgia (2.71/100,000), New York (2.16/100,000), California (2.02/100,000), Florida (1.90/100,000), and Texas (1.39/100,000), with significantly decreasing trends over time, except Georgia where rates increased (AAPC = 1.8).

Conclusions: Although KS incidence rates have decreased nationally, age, racial, and geographic disparities persist, including increasing risk among younger Black men and particularly elevated rates in some southern states and urban areas. Further research is needed to address racial and geographic AIDS-related KS disparities.

aSection of Gastroenterology and Hepatology, Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX;

bClinical Epidemiology and Comparative Effectiveness Program, Department of Medicine, VA Health Services Research Center of Innovations (IQuESt), Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX;

cTexas Medical Center Digestive Diseases Center, Houston, TX;

dDan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX;

eCenter for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX;

fSection of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX;

gDepartment of Medicine, Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA;

hDivision of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA;

iSection of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX; and

jDivision Infectious Diseases, Department of Internal Medicine, Baylor College of Medicine, Houston, TX.

Correspondence to: Elizabeth Chiao, MD, MPH, Department of Medicine, Houston VA Medical Center, Baylor College of Medicine, 152, 2002 Holcombe Boulevard, Houston, TX 77030 (e-mail: echiao@bcm.edu).

Supported by the National Cancer Institute (R01CA206476, PI: E.C.); the Houston Veterans Affairs Health Services Research and Development Center of Innovations (CIN13-413); and the Dan L. Duncan Cancer Center (P30CA022453). D.L.W. and J.M.G. receive research support from the US Department of Veterans Affairs (CX001430 D.L.W., BX000507 and I01 CX000174 J.M.G., respectively), and J.M.G., L.J., and E.C. from the National Institutes of Health (AG040583-J.M.G., R01CA172880-L.J., and T32 CA174647, respectively). L.J. receives research support from Cancer Prevention Research Institute of Texas (IIR RP140767). A.P.T. is supported by the Creative and Novel Ideas in HIV Research (CNIHR) Program through a supplement to the University of Alabama at Birmingham (UAB) Center For AIDS Research funding (P30 AI027767), and National Cancer Institute (R01CA206476). This funding was made possible by collaborative efforts of the Office of AIDS Research, the National Institute of Allergy and Infectious Diseases, and the International AIDS Society. The funders played no role in design, interpretation, or design to publish study findings.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received November 28, 2018

Accepted March 07, 2019

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