Comparative analysis of demographics and outcomes in young versus average onset hospitalized gastrointestinal cancer patients in New York State.

Abstract

1592 Background: Recent studies have shown an increasing incidence of gastrointestinal (GI) cancers among young patients. This study investigates clinical outcomes and healthcare utilization among young ( < 50) versus average onset (≥50) GI cancer patients admitted to hospitals in New York State (NYS). Methods: We performed a retrospective analysis using the Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2022. Patients were divided into two groups: young-onset GI cancer patients (YOGIC, < 50 years) and average-onset GI cancer patients (AOGIC, ≥50 years). GI cancers included anal, biliary tract, colorectal, esophageal, gallbladder, liver, pancreatic, peritoneal, small intestine, and stomach cancers. The study population was further stratified by demographic and clinical characteristics. All variables were compared using the Kruskal-Wallis test or Fisher’s exact test, along with multivariate linear and logistic regression in RStudio version 4.4.2, with a significance level of p ≤0.05. Clinical characteristics, including severity of illness and risk of mortality, were defined using the All Patient Refined (APR) grading system. Results: A total of 256,924 patients were identified (26,071 YOGIC and 230,853 AOGIC) with a primary admitting diagnosis of a GI cancer from 2009 to 2022. The AOGIC group had a higher proportion of white and female patients, whereas the YOGIC group included a higher proportion of black and male patients (p < 0.001). Anal, peritoneal, and stomach cancers were more prevalent in YOGIC, while pancreatic and esophageal cancers were more common among AOGIC (p < 0.001). AOGIC patients were more likely to have extreme (13% vs. 9.7%) or major (39% vs. 32%) severity of illness compared to YOGIC (p < 0.001). However, the median total cost of stay for YOGIC was significantly higher than that for AOGIC ($21,421 vs. $19,658 respectively, p < 0.001). YOGIC patients were more likely to undergo procedures during hospitalization (95%) compared to AOGIC (93%) (p < 0.001). YOGIC patients were more likely to be discharged home (66%) vs. AOGIC (48%) (p < 0.001). Longer hospital stays were associated with patients diagnosed with esophageal, peritoneal, and stomach cancers (p < 0.001) versus the reference group (anal cancer), and in AOGIC [log fold-change 0.029 (95% CI: 0.021-0.038), p < 0.001]. Despite a higher mortality risk in AOGIC, mortality rates decreased faster over the study period [OR 0.97 (95% CI: 0.96-0.98), p < 0.001]. Conclusions: AOGIC patients experience a higher risk for mortality and longer hospital stays. However, YOGIC patients undergo further procedural interventions and have been found to have higher inpatient admission costs. Policies focused on earlier outpatient interventions may alleviate the burden on inpatient care.