Impact and disparities of COVID-19 on hematological malignancies: A database study focused on hospitalized patients in North America.

Abstract

e23322 Background: The COVID-19 pandemic has presented significant risks to the hematological malignancy patients worldwide, including elevated hospitalization rates and increased fatality. However, data pertaining to hospitalized patients in United States are not comprehensively reported. We examined Multiple myeloma (MM) and leukemia (Leuk) patients admitted with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) to US hospitals in 2021. Methods: We obtained 2021 National Inpatient Sample database and further utilized generalized linear models to assess the association between COVID-19 infection among MM and Leuk and clinical outcomes, septicemias, emergency admissions, healthcare-associated complications (HAC including infectious complications), mortality, neurological disorders (ND), length of stay (LOS), cost and mortality, while controlling for patient and clinical characteristics. Results: In the study there were 7550 COVID-19 infections among 114665 MM patients and 3630 COVID-19 infections among 93320 Leuk patients. In the adjusted analysis, MM patients with COVID-19 were significantly associated with longer LOS (Coeff:1.82, 95%CI: 1.63-2.03); higher cost (Coeff:1.43; 95%CI: 1.32-1.56); higher mortality (aOR:5.98, 95%CI: 5.12-6.99); septicemia (2.56; 95%CI: 2.22-2.87); HAC (aOR: 2.22; 95%CI: 1.96-2.51); ND (aOR: 1.24; 95%CI: 1.07-1.45); emergency admissions (aOR:1.73; 95%CI: 1.44-2.07); fluid and electrolyte imbalance (aOR:1.54; 95%CI: 1.38-1.73). All outcomes were comparable in the Leuk cohort, except cost (Coeff:1.12; 95%CI:0.99-1.27). In the MM, compared to Whites, Hispanics (Coeff: 1.43; 95%CI: 1.32-1.57), Asians and Other races (Coeff: 1.24; 95%CI: 1.13-1.37) were associated with higher cost. In the Leuk cohort compared to Whites, Hispanics (aOR:1.17; 95%CI:1.02-1.35), Asians (aOR:1.23; 95%CI:1.06-1.43) and Others were also associated with higher HAC and septicemias (Hisp-aOR:1.22; 95%CI:1.05-1.42), (Asians-aOR:1.26; 95%CI:1.07-1.48). In MM and Leuk cohorts, compared to males, females were associated with higher ND (MM-aOR:1.17; 95%CI:1.08-1.45; Leuk--aOR:1.28; 95%CI:1.16-1.41). Conclusions: This comprehensive nationwide-database analysis showed that patients with multiple myeloma and leukemia who were hospitalized with severe SARS-CoV-2 had increased odds to experience higher mortality, septicemia and HAC. This dataset also shows women may face higher risks from COVID-induced neurological disorders. Additionally, the outcomes were noted to have significant racial and healthcare cost disparities. Challenges associated with COVID-19 persist in hematological cancer patients. Further investigation of these findings and public health measures focused on minorities to improve access and implementation of care are necessary to avoid such disparities and decrease healthcare costs.