Age and racial disparities in esophageal cancer admissions, comorbidities, and outcomes: A nationwide analysis from 2016-2021.

Abstract

e16084 Background: Esophageal carcinoma (EC) is increasingly prevalent among younger adults, particularly among Hispanics. This malignancy is driven by a complex interplay of genetic and environmental factors, including gastroesophageal reflux disease (GERD), obesity, and smoking. This study investigates national disparities in EC outcomes to improve patient care and inform public health interventions. Methods: Utilizing the National Inpatient Sample database from 2016 to 2021, we identified adult patients diagnosed with primary esophageal carcinoma. Patients were stratified by age (< 40 years vs. ≥40 years) and racial categories (White, Black, Hispanic, Asian/Pacific Islander [AAPI], American Indian/Native American [AI/AN]). Our statistical analysis included Chi-square tests for categorical variables and t-tests for continuous variables to assess differences in hospital outcomes, treatment modalities, and patient demographics. Results: Analysis revealed that 7.6% of EC admissions involved younger patients (< 40 years), with Whites constituting the majority of cases (63.02%), followed by Blacks (21.19%), Hispanics (7.67%), Asians/Pacific Islanders (AAPI) at 4.44%, and American Indians/Native Americans (AI/AN) at 3.68%. Hispanic patients exhibited the highest rates of type II diabetes, a key comorbidity in EC progression. The highest rates of obesity were observed in White patients, followed closely by Hispanics. Despite similar mortality rates across age groups, which did not show significant differences (p = 0.381), AI/AN experienced the highest mortality rate (10.69%). Both the length of hospital stay and hospitalization costs varied significantly by race, with younger patients and AAPI incurring the highest costs, indicating disparities in access to care or treatment complexity. Conclusions: The study reveals profound disparities in the treatment and outcomes of esophageal carcinoma, highlighting its uniformly aggressive progression across all age groups. The consistent mortality rates indicate the need for more screening and treatment strategies, especially for younger patients who could benefit from earlier interventions. Significant racial disparities in hospital stay lengths, costs, and mortality underscore the urgency of reevaluating clinical pathways to enhance healthcare equity. Future research should integrate detailed analyses of socioeconomic and disease-specific factors to improve screening/treatment guidelines, which aim to target high risk groups.