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

Vaishali Deenadayalan John H. Stroger, Jr. Hospital of Cook County, Chicago, IL info_outline Vaishali Deenadayalan, Siri Chandana Swarna, Jay Vakil, Junglee Kim, Ekrem Turk, Shweta Gupta

Authors Vaishali Deenadayalan John H. Stroger, Jr. Hospital of Cook County, Chicago, IL info_outline Vaishali Deenadayalan, Siri Chandana Swarna, Jay Vakil, Junglee Kim, Ekrem Turk, Shweta Gupta Organizations John H. Stroger, Jr. Hospital of Cook County, Chicago, IL Abstract Disclosures 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 Outcomes WH AA HISP Adjusted Odds Ratio P value Mortality (N) 4880 1390 1100 0.006 Mortality in AA comp to WH 1.08 (0.92-1.27) 0.323 Mortality in HISP comp to WH 1.24(1.03-1.48) 0.022 LOS in days 7.78 9.11 9.44 < 0.001 THC in $ 74,126 90.680 123,894 < 0.001 Secondary Outcomes (%) p value Sepsis 6.09 8.09 9.79 Sig for AA, HISP < 0.001 Shock 3.1 3.91 5.47 Sig for HISP < 0.001 Intubation 7.84 10.96 10.94 Sig for AA, HISP < 0.001 Blood transfusion 7.25 10.39 11.12 Sig for AA, HISP < 0.001