Disparities in outcomes of esophageal cancer hospitalizations: A trend analysis (2008-2021).

Abstract

e16156 Background: Esophageal cancer has a poor prognosis with a 21.6% five-year relative survival and demographic variations have been reported with esophageal cancer. This study aims to identify trends in demographic-specific disparities in mortality among esophageal cancer admissions. Methods: This is a retrospective longitudinal trends study using the Nationwide Inpatient Sample (NIS) database (2008-2021). We identified hospitalizations with esophageal cancer using ICD-9 and ICD-10 codes. The study highlights disparities in mortality outcomes stratified by age, gender and race categories. Results: There were 527,128 hospitalizations of esophageal cancer patients between 2008 and 2021. Over the period, the mean age at hospitalization increased from 66 years to 67 years (P < 0.001). Majority of the admissions were elderly patients (≥65 years) and Caucasians (P < 0.001). Most patients had Medicare and were in large and urban teaching hospitals (P < 0.001). The overall inpatient mortality rate declined from 10.2% in 2008 to 8.7% in 2019, followed by an increase to 9.2% in 2021 (P trend = 0.018). While the young adult population (< 45 years) showed a trend towards rising mortality, it was not statistically significant (P trend = 0.17). Significant reductions in mortality were observed only in patients aged ≥65 years (P trend = 0.004). In the gender subgroup analysis, males experienced a notable decline in mortality (P trend = 0.014). Among racial groups, only Caucasians showed a significant improvement in mortality trends (P trend = 0.006) over the study period. Conclusions: Inpatient mortality among esophageal cancer admissions has improved overall; however, significant demographic-related disparities were identified. Coordinated efforts to reduce these disparities will be essential in attaining sustained improvements in outcomes for esophageal cancer. Disparities in outcomes of esophageal cancer hospitalizations: A trend study (2008-2021). Mortality rate, %       2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 P- Trend value Overall 10.19 9.55 9.05 9.16 9.46 9.22 8.94 9.05 8.97 8.94 8.68 8.66 9.15 9.19 0.02 Young (<45 years) 7.37 5.87 5.98 11.43 8.76 6.1 10.16 5.34 7.22 9.62 10.14 8.96 9.68 8.1 0.17 Middle-aged (45- 64 years) 10.02 8.01 8.77 8.83 8.8 8.42 8.38 8.66 8.54 8.73 7.99 8.13 8.77 9.03 0.48 Elderly (>65 years) 10.48 10.89 9.46 9.28 10 9.97 9.28 9.51 9.34 9.05 9.06 8.99 9.36 9.32 0.004 Females 8.09 8.41 8.34 9.28 9.17 7.93 8.16 7.52 7.83 8.76 7.96 7.83 8.39 8.8 0.61 Males 10.79 9.89 9.26 9.13 9.54 9.59 9.14 9.47 9.27 9 8.87 8.91 9.35 9.29 0.01 Whites 10.56 9.62 9.26 9.15 9.23 8.92 8.73 8.93 8.86 8.72 8.28 8.54 9.18 9.21 0.006 Blacks 11.09 9.5 8.99 9.6 10.54 10.71 9.93 8.15 8.89 10.09 9.3 9.73 8.12 9.5 0.27 Hispanics 9.23 9.2 7.04 12.16 10.38 8.06 9.39 8.4 8.6 9.61 9.51 8.81 9.56 9.58 0.87