B0173 - African Americans Have Higher Inpatient Mortality at a Younger Age: A Nationwide Inpatient Sample Database Analysis

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Pranav D. Patel, MD

Geisinger Medical Center
Danville, PA

Pranav D. Patel, MD¹, Yash Shah, MD², Deepa P. Budh, MD³, Dhruvan Patel, MD⁴, Benyam Addissie, MD⁵
¹Geisinger Medical Center, Danville, PA; ²Hackensack Meridian Ocean Medical Center, Brick, NJ; ³St. Barnabas Health System, Bronx, NY; ⁴Mercey Fitzgerald Hospital, Darby, PA; ⁵Geisinger Health System, Danville, PA

Introduction: Colorectal cancer (CRC) is the 3rd most common cause of cancer-related death in women and 2nd in men in the US. CRC incidence and mortality have been trending down with better screening strategies. Significant disparities are still reported to remain among certain races/ethnicities and age groups. In this study, we assessed CRC-related outcomes in African Americans (AA) as compared to Caucasians to understand racial and age disparities.

Methods: We used the Nationwide Inpatient Sample (NIS) database from 2008 and 2019. Previously validated ICD-10-CM codes identified CRC. CRC patients were divided into two groups Caucasians and AA. Univariate logistic regression for categorical variables and linear regression for continuous variables was carried out to identify independent associations at p < 0.05. Statistical Analysis was performed using R studio. Age of hospitalization and racial distribution was studied along with the other comorbidities.

Results: A total of 2,569,516 inpatient admissions were included. 410,139 were AA and 2,159,377 were Caucasians (Table.1). AA’s have a younger age at admission with a mean age of 63 years compared to 68 years in Caucasians (p< 0.001). AA’s have a higher percentage of inpatient admissions in the younger population between the ages of 28 to 67. Caucasians have a higher percentage of inpatient admission due to CRC after 68 years of age. Despite their relatively younger age, AA’s have significantly higher inpatient mortality (5.9%) compared to Caucasians (4.9%) (p< 0.001). More AA’s (51%) had low median household income of $1-24999 in contrast to Caucasians (23%). AA’s have a higher percentage of use of Medicaid (18% vs. 6.7%) and Caucasians have a higher percentage of Medicare (59% vs 49%). The disparity in mortality remained significantly higher in the AA population compared to Caucasians even after controlling household income and type of insurance.

Discussion: Despite advances in CRC screening and treatment, racial disparities in outcomes continue to exist. This study found that AA’s with colorectal cancer have consistently higher inpatient mortality rates compared to Caucasians with a widening gap from 2015 to 2019 (figure 1). AA’s with colorectal cancer are also being hospitalized at younger ages compared to their Caucasian counterparts. These disparities are most likely due to a number of social determinants of health. Future screening and treatment guidelines need to recognize these factors in order to improve equity in colorectal cancer outcomes.

Figure: Figure 1. Trends of Inpatient mortality due to CRC comparing AA(African Americans) and white(Caucasians) between the years 2008-2019

Table 1. Demographics		Caucasians, N = 2,159,377	African American, N = 410,139	p-value
	Age in years at admission	68 (58, 78)	63 (54, 72)	< 0.001
	Sex			< 0.001
	Male	1,071,773 (50%)	191,960 (47%)
	Female	1,086,925 (50%)	218,014 (53%)

	PAY			< 0.001
	Medicare	1,262,570 (59%)	199,569 (49%)
	Medicaid	144,929 (6.7%)	72,952 (18%)
	Private	654,826 (30%)	106,884 (26%)
	Self Pay	43,274 (2.0%)	16,563 (4.0%)
	No charge	4,346 (0.2%)	1,772 (0.4%)
	Other	46,231 (2.1%)	11,644 (2.8%)
	Median household income			< 0.001
	$1- 24999	487,393 (23%)	202,340 (51%)
	$25000-34999	565,496 (27%)	84,672 (21%)
	$35000-44999	542,108 (26%)	66,013 (17%)
	$45000+	527,105 (25%)	46,966 (12%)
	Age_Group			< 0.001
	18-27	8,081 (0.4%)	2,417 (0.6%)
	28-37	37,429 (1.7%)	11,177 (2.7%)
	38-47	125,799 (5.8%)	33,865 (8.3%)
	48-57	350,485 (16%)	91,595 (22%)
	58-67	528,264 (24%)	119,722 (29%)
	68-77	561,376 (26%)	90,141 (22%)
	78-87	418,539 (19%)	48,858 (12%)
	88 and above	129,404 (6.0%)	12,364 (3.0%)
	Obesity	206,028 (9.5%)	41,133 (10%)	< 0.001
	Smoking	124,563 (5.8%)	24,672 (6.0%)	0.005
	DM	384,959 (18%)	92,562 (23%)	< 0.001
	HLD	624,296 (29%)	93,668 (23%)	< 0.001
	HTN	756,288 (35%)	175,882 (43%)	< 0.001
	Alcohol	23,310 (1.1%)	3,195 (0.8%)	< 0.001
	UC (Ulcerative colitis)	16,423 (0.8%)	1,876 (0.5%)	< 0.001
	CD (Crohn's disease)	12,967 (0.6%)	1,408 (0.3%)	< 0.001
Table 2.	OUTCOMES (UNIVARIATE ANALYSIS)
	Inpatient Mortality	104,918 (4.9%)	24,042 (5.9%)
	Length of stay (cleaned) (days)	5.0 (3.0, 8.0)	5.0 (3.0, 9.0)	< 0.001
	Total charges (cleaned) ($)	$42,842 (23,051, 77,615)	$42,248 (21,937, 80,273)	0.2

Table: Table 1: Demographics of Colorectal cancer hospitalizations in Caucasians and African Americans
Table 2: Outcome of Colorectal cancer hospitalizations in Caucasians and African Americans

Disclosures:

Pranav Patel indicated no relevant financial relationships.

Yash Shah indicated no relevant financial relationships.

Deepa Budh indicated no relevant financial relationships.

Dhruvan Patel indicated no relevant financial relationships.

Benyam Addissie indicated no relevant financial relationships.

Pranav D. Patel, MD¹, Yash Shah, MD², Deepa P. Budh, MD³, Dhruvan Patel, MD⁴, Benyam Addissie, MD⁵. B0173 - African Americans Have Higher Inpatient Mortality at a Younger Age: A Nationwide Inpatient Sample Database Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.