Disparities in patients diagnosed with cancer in the inpatient and outpatient settings.

Abstract

e13839 Background: Patients diagnosed with cancer in the Emergency Department or while hospitalized have been shown to present at later stages, have poorer clinical outcomes, worse mortality, and higher healthcare costs than those diagnosed outpatient. However, current research has provided little insight into which patients are at highest risk for being diagnosed while hospitalized except to acknowledge that those with health-related social needs (HRSN) are most vulnerable. This study aims to explore the link between HRSN and inpatient cancer diagnoses to help identify high-risk patients earlier, and to compare HRSN between patients diagnosed inpatient and those diagnosed through outpatient preventive screenings. Methods: A single-institution retrospective, electronic health records chart review was performed at an urban, tertiary care academic medical center that is a large safety-net hospital in New England. All patients with a new diagnosis of primary lung, breast, colon, prostate, and cervical cancers who were evaluated in either the inpatient or outpatient setting from January 1, 2016 to December 31, 2023 were reviewed. Baseline sociodemographic data, diagnosis location, data pertaining to primary care physician relationship, and individual bio-clinical factors were reviewed. A multivariable logistic regression analysis was performed to assess the relationship between location of diagnosis as a dependent variable and multiple, potentially confounding explanatory variables. Results: 485 participants were included in this study (71 diagnosed inpatient; 414 diagnosed outpatient). Disparities between location of diagnosis and sex, primary language spoken, insurance status, Charlson Comorbidity Index (CCI), and having an established primary care physician (PCP) were observed. Conclusions: Our results reinforce findings that patients diagnosed while inpatient present with more advanced disease, are less likely to have insurance and routine outpatient follow up, have more comorbidities, and have reduced survival after diagnosis. Patients who are female and who identified English as their primary language are more likely to be diagnosed while inpatient; race, social vulnerability index (SVI), and abnormal prior screening results did not impact the likelihood of an inpatient diagnosis. These findings may help identify high-risk patients for targeted preventive screening in outpatient settings. Comparative studies by location of diagnosis (inpatient as reference). Variable Odds Ratio 95% Confidence Interval p-value Sex (female) 1.11 1.03, 1.20 0.008* Language (English) 1.09 1.02, 1.17 0.015* Race (White) 1.02 0.94, 1.10 0.669 SVI 0.88 0.74, 1.04 0.135 Presence of insurance 0.85 0.76, 0.95 0.005* CCI 1.03 1.02, 1.04 <0.001* Established PCP 0.76 0.70, 0.82 <0.001* Abnormal prior screening results 0.86 0.71, 1.05 0.146 *Statistically significant at the level of p<0.05.