Breast care outcomes and infectious disease: Insights from COVID-19.

Abstract

e13086 Background: Adverse inpatient outcomes with COVID-19 have been well characterized for aggregations of all cancer types. However, the unique pathophysiology and treatment of breast cancer warrant specific analysis. Therefore, a critical gap exists with regard to breast cancer hospitalizations specifically to better inform clinical decision making and resource planning. We aimed to characterize inpatient mortality, morbidity, and resource utilization among breast cancer patients with concurrent COVID-19 infections to address this gap. Methods: We identified hospitalization cases from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality from 2020-2022 that met the inclusion criteria of female adults ≥ 18 years old with hospitalizations containing a primary or secondary ICD-10 code for diagnosis of breast cancer. Non-normally distributed results were compared using Mann-Whitney U test, and categorical variables were compared using Pearson’s chi-square test. Multivariate logistic regression models compared inpatient mortality and COVID-19 and survey-weighted negative binomial regression estimated the association between COVID-19 and inpatient length of stay. All analyses were performed using Stata version 19 (StataCorp LP, College Station, TX). Results: We identified 97,288 hospitalizations meeting inclusion criteria of which 4,933 (5.1%) cases were diagnosed with COVID-19. COVID-19 was independently associated with statistically significantly higher odds of inpatient mortality (11.1% vs 4.9%), septic shock (5.3% vs 2.9%), acute respiratory failure (38.6% vs 10.9%), mechanical ventilation (11.7% vs 5.1%), and longer length of hospital stay (3.0-10.0 days vs 2.0-6.0) (p < 0.001). Increased mortality was additionally associated with age 80 years and older (AOR 2.915, 95% CI 2.209–3.845, p < 0.001), non-Hispanic Black patients (AOR 1.214, 95% CI 1.117-1.320, p < 0.001), metastatic cancer (AOR 3.230, 95% CI 3.032-3.440, p < 0.001), chronic renal failure (AOR 1.309, 95% CI 1.170-1.464, p < 0.001), congestive heart failure (AOR 1.106, 95% CI 1.001-1.223, p = 0.048), and chronic pulmonary disease (AOR 1.169, 95% CI 1.068-1.280, p = 0.001). Conclusions: Breast cancer patients hospitalized with COVID-19 experienced statistically significant higher inpatient mortality, greater morbidity, and longer hospital stays compared with those without COVID-19 even after adjustment for comorbidities and hospital factors, highlighting the increased vulnerability of this population during infectious disease surges. Targeted clinical monitoring, timely prevention strategies, and early intervention may help mitigate these risks, underscoring the need for continued attention to breast cancer–specific outcomes during and beyond public health emergencies.