Racial disparities and clinical outcomes among cancer patients admitted with SARS-CoV-2 infection: A nationwide analysis.

Authors

Vaishali Deenadayalan

Vaishali Deenadayalan

John H. Stroger, Jr. Hospital of Cook County, Chicago, IL

Vaishali Deenadayalan , Siri Chandana Swarna , Jay Vakil , Junglee Kim , Ekrem Turk , Shweta Gupta

Organizations

John H. Stroger, Jr. Hospital of Cook County, Chicago, IL

Research Funding

No funding received
None.

Background: The novel SARS COV2 pandemic highlighted existing racial disparities in US healthcare. The impact was further amplified in the cancer community. We studied the racial disparities in the clinical outcomes of cancer patients who were hospitalised with COVID-19 infection. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2020 was queried to identify adult patients (Age > 18 years) admitted for COVID with underlying cancer using the ICD-10 codes. Study population was stratified based on race (White vs African Americans vs Hispanics). Primary outcomes included mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included prevalence of pulmonary embolism (PE), ICU admission, acute respiratory failure (ARF), blood transfusion, and sepsis. Statistics were performed using multivariate linear and logistic regression using STATA v17. Results: There were 53,465 adult admissions for COVID in cancer patients. Among them 30,605 (58.8%) were White (WH), 9580 (18.4%) were African Americans (AA), 8225 (15.8%) were Hispanics (HISP). HISP and AA were significantly younger compared to WH (61.7 vs 65.8 vs 72.4, p < 0.001). HISP had lowest Charlson comorbidity index (CCI) compared to whites (50.4% vs 67.7%, p < 0.001). AA had highest rates of all medical comorbidities except dyslipidemia and COPD which was higher in WH. Of the 8135 (15.2%) patients that died during the admission, 60% (N = 4880) were WH, 17.1% (N = 1390) were AA whereas 13.5% (N = 1100) were HISP. Compared to WH, HISP had a higher odds of mortality (aOR 1.24, 95% CI 1.03-1.48; p = 0.022), there was no difference in the odds of mortality between WH and AA. The LOS was increased for AA and HISP compared to WH (9.1 vs 9.44 vs 7.78 days, p < 0.001). The total hospitalization charges was also higher for AA and HISP compared to WH ($90,680 vs $123,894 vs $74,126, p < 0.001). HISP patients had higher odds of requiring intubation, blood transfusion, shock and sepsis than WH. Conclusions: Despite being significantly younger with lower comorbidity burden, HISP, had an increased odds of mortality compared to WH patients. Contrary to reported literature (PMID: 35344045), there was no significant difference in the odds of mortality between WH and AA. Further studies are needed to explore the reasons for high mortality in HISP patients.

Odds ratio for Primary and Secondary Outcomes.

Primary OutcomesWHAAHISPAdjusted Odds RatioP value
Mortality (N)4880139011000.006
Mortality in AA comp to WH1.08 (0.92-1.27)0.323
Mortality in HISP comp to WH1.24(1.03-1.48)0.022
LOS in days7.789.119.44< 0.001
THC in $74,12690.680123,894< 0.001
Secondary Outcomes (%)p value
Sepsis6.098.099.79Sig for AA, HISP< 0.001
Shock3.13.915.47Sig for HISP< 0.001
Intubation7.8410.9610.94Sig for AA, HISP< 0.001
Blood transfusion7.2510.3911.12Sig for AA, HISP< 0.001

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Health Services Research and Quality Improvement

Track

Quality Care/Health Services Research

Sub Track

Access to Care

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e18568)

DOI

10.1200/JCO.2023.41.16_suppl.e18568

Abstract #

e18568

Abstract Disclosures

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