Comparison of demographics, mortality outcomes and resource utilization in early-onset versus later-onset pancreatic cancer: An analysis of the US National Inpatient Sample (NIS).

Abstract

700 Background: Pancreatic cancer is associated with higher mortality, with 5-year relative survival of 12%. Early-onset pancreatic cancer (EOPC) is relatively uncommon and is seen in 5-12% of the cases. Recent studies indicate a rising trend in the incidence of EOPC. In this study, we categorized EOPC for ages less than 50 and later-onset pancreatic cancer (LOPC) for ages above or equal to 50 years. The aim of the study is to understand difference in demographics, mortality, and resource utilization between the two sub-categories of patients admitted to acute care hospitals in the United States. Methods: This is a retrospective cohort study of adult patients hospitalized with pancreatic cancer as the primary diagnosis at acute care hospitals across the United States in 2021, using the National Inpatient Sample (NIS) database. International Classification of Diseases, 10th Revision (ICD-10) codes were utilized to identify patients with a primary diagnosis of pancreatic cancer. The primary outcome is comparing demographics and in-hospital mortality between EOPC and LOPC. The secondary outcomes are length of stay (LOS) and total hospitalization charges. We performed multivariate logistic regression analysis to assess in-hospital mortality, LOS, and total hospitalization charges after adjusting for potential confounders such as sex, race, Charlson comorbidity index, hospital teaching status, and hospital region. Results: Our study included 38,654 patients with pancreatic cancer, of which 2,242 were EOPC and 36,412 were LOPC. The majority of the baseline characteristics were similar in both groups, except that EOPC has a higher Hispanic population (16.06% versus 8.77 %, p < 0.001), higher Medicaid as the payer source (28.28 % versus 7.32%, p < 0.001), and a more significant number of patients admitted to an urban teaching hospital (89.2 % versus 85.2%, p < 0.05) compared to LOPC subpopulation. No statistically significant difference in mortality was found between the two sub-categories (odds ratio 0.97, 95 % CI 0.60-1.5). Charlson index, hospital location, hospital bed size, and hospital region are independent predictors of mortality. There was no statistically significant difference between the two sub-categories for mean length of stay and total hospitalization charges. Conclusions: No significant difference was observed between EOPC and LOPC regarding in-hospital mortality, total length of stay, and total hospitalization charges. Our study highlights that EOPC disproportionately affects the Hispanic population and also a greater number of EOPC patients being admitted to urban teaching hospitals. Future research is needed to understand the disproportionate effect on the Hispanic population in the EOPC group and continued research in the domain, as the incidence of early-onset pancreatic cancer is expected to rise.