Disparities in race and insurance status among hospitalized patients with pancreatic cancer and protein–energy malnutrition: A nationwide analysis, 2016–2022.

Abstract

11052 Background: Protein–energy malnutrition (PEM) is frequently encountered in patients with pancreatic cancer and is associated with worse clinical outcomes. Although sociodemographic differences in malnutrition risk have been described, it is unclear whether racial and insurance-based disparities persist after accounting for clinical complexity, socioeconomic factors, and hospital characteristics. We sought to identify independent predictors of PEM among hospitalized patients with pancreatic cancer using a nationally representative inpatient cohort with multivariable adjustment for relevant covariates. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2016 to 2022. Adult hospitalizations with pancreatic cancer were identified using ICD-10-CM code C25, and PEM was defined using ICD-10-CM codes E40–E46. Multivariable regression models evaluated independent predictors of PEM and its associations with in-hospital mortality, length of stay, discharge disposition, and hospital charges. Models adjusted for demographic factors, comorbidities, and hospital characteristics, with survey weights applied to generate national estimates. Results: Among an estimated 263,890 hospitalizations for pancreatic cancer, 37% were associated with PEM. After adjustment, Black patients (adjusted odds ratio [aOR] 1.39, 95% CI 1.31–1.48) and Asian/Pacific Islander patients (aOR 1.41, 95% CI 1.27–1.56) had higher odds of PEM compared with White patients. Medicaid insurance was associated with increased odds of PEM (aOR 1.12, 95% CI 1.03–1.22), whereas private insurance was associated with lower odds (aOR 0.85, 95% CI 0.80–0.91) relative to Medicare. Higher comorbidity burden (Charlson Comorbidity Index ≥3) was the strongest predictor of PEM (aOR 1.54, 95% CI 1.45–1.64). Median household income was not independently associated with PEM. PEM was more common in urban hospitals and those with larger bed size. Conclusions: In this national inpatient cohort, PEM was common among patients hospitalized with pancreatic cancer and demonstrated racial and insurance-based disparities that persisted after adjustment for income, comorbidities, and hospital characteristics. These findings highlight potential gaps in nutritional risk recognition and underscore the importance of standardized inpatient nutritional screening and targeted interventions for high-risk populations. Variable aOR 95% CI P value Age 50–64 1.20 1.03–1.38 0.016 Age ≥65 1.25 1.08–1.46 0.004 Female sex 0.94 0.91–0.98 0.006 Black race 1.39 1.31–1.48 <0.001 Asian/Pacific Islander 1.41 1.27–1.56 <0.001 Other race 1.23 1.10–1.38 <0.001 Medicaid insurance 1.12 1.03–1.22 0.010 Private insurance 0.85 0.80–0.91 <0.001 Charlson Index ≥3 1.54 1.45–1.64 <0.001