Gender and racial disparities in acute in-hospital outcomes of hairy cell leukemia across the US, 2010-2021.

Abstract

e19034 Background: Hairy cell leukemia (HCL) has a marked male predominance, with a 4:1 male-to-female ratio in recent studies. Emerging evidence indicates the presence of gender and racial disparities in the outcomes of HCL. Here, we examined racial and Sex disparities in acute in-hospital outcomes among patients with HCL across the US. Methods: We analyzed adult hospitalizations with a principal diagnosis of hairy cell leukemia from 2010–2021 Nationwide Inpatient Sample database using ICD-10 codes. Men and women were identified based on the sex assigned at birth. Demographic characteristics were compared using Pearson’s χ² tests and Student’s t-tests. The primary outcomes include gender and racial disparities in mortality. Secondary outcomes include the rates of venous thromboembolism (VTE) and major adverse cardiovascular events (MACEs), along with the influence of gender and race on these outcomes. Illness severity, mortality risk, and comorbidity burden were adjusted using the All Patient Refined-Diagnosis Related Groups (APR-DRG), specifically for Likelihood of Dying (LOD). MACE was defined as any occurrence of acute nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Results: We included 5,685 hospitalizations for hairy cell leukemia in the analysis. The cohort consisted of 3,519 men (61.9%) and 2,166 (38.1%) women. There were 4,076 white Americans (71.7%), 830 black Americans (14.6%), 358 Hispanics (6.3%), 74 Asian/Pacific Islanders (1.3%), and 11 native Americans (0.2%) and 341 others (6%). The overall mortality rate was noted as 345 (6.1%). Mortality rates were not significantly different between women and men (135 [6.2%] vs. 210 [6%]; P=0.745). The patient's sex was not a significant predictor of mortality in multivariable regression (female vs male: aOR: 0.74; 95% CI: 0.38-1.45; P=0.378). Asian race (aOR: 2.25; 95% CI: 1.29-3.12; P=0.024); extreme LOD at admission (aOR: 3.27; 95% CI: 1.39-5.72; P=0.007), hyperthyroidism (aOR: 2.48; 95% CI: 2.46-4.81; P=0.005), malnutrition (aOR: 1.62; 95% CI: 1.05-3.08; P=0.003) and venous thromboembolism (aOR: 2.26; 95% CI: 1.64-4.08; P = 0.010) were significantly associated with increased likelihood of mortality. Incidence of VTE was 8.1% (460 cases) and was higher among men than women in the study (330 cases [9.4%] vs 130 cases [6%]; P<0.001). Incidence of VTE was highest among individuals of black 75 (9%) and white American descent 350 (8.6%) compared with those of Hispanic descent 10 (2.8%) and other mixed races 15 (4.4%). The incidence of MACEs was 1.5% (85 cases). The incidence of MACEs was similar among men and women (55 [1.6%] vs. 30 [1.4%]; P=0.801). Conclusions: While sex was not a significant predictor of mortality or MACEs, male patients demonstrated a higher risk of VTE. Racial disparities were evident, with Asian race with increased mortality risk and American descent with greater odds of VTE.