Income inequality and cervical cancer: A comparative analysis of demographics and healthcare burden of women in the lowest and highest income quartiles.

Abstract

5521 Background: Cervical cancer disproportionately affects women of lower socioeconomic status, yet comprehensive data comparing the demographic profiles and comorbidity burden across income strata remain limited. This study examines differences in patient characteristics, comorbidities, and healthcare utilization between women in the lowest and highest income quartiles hospitalized with cervical cancer in the United States. Methods: We identified women hospitalized with cervical cancer in the United States between 2016 and 2022 using ICD-10 codes C53.x in the National Inpatient Sample. Patients were classified into the lowest (0–25th percentile) and highest (76th–100th percentile) income quartiles based on median household income for their residential ZIP code. We compared demographic characteristics including age, race, socioeconomic distribution, and clinically relevant comorbidities across the two groups. Healthcare utilization was evaluated by analyzing length of stay and inflation-adjusted mean hospital charges. Results: We identified 88,240 women hospitalized with cervical cancer; 69.7% were in the lowest income quartile and 30.3% in the highest. Women in the highest income quartile were older (mean age 55.45 vs. 52.62 years, p<0.001) and incurred higher inflation-adjusted hospital charges ($88,955 vs. $76,121, p<0.001), though length of stay was comparable (5.64 vs. 5.82 days, p=0.134). Significant racial disparities were evident: the highest income quartile had more White patients (63.2% vs. 46.2%) while the lowest quartile had more Black (29.1% vs. 11.1%) and Hispanic (19.0% vs. 12.2%) patients (p<0.001). Women in the lowest income quartile had significantly higher prevalence of smoking (40.2% vs. 31.0%), diabetes (19.8% vs. 13.8%), chronic kidney disease (16.6% vs. 14.0%), obesity (14.4% vs. 11.5%), HIV (2.1% vs. 0.9%), depression (12.1% vs. 10.9%), opioid use disorder (3.1% vs. 1.9%), drug abuse (7.7% vs. 3.5%), and alcohol abuse (2.0% vs. 1.4%) (all p<0.05). Conversely, the highest income quartile had higher rates of metastatic cancer (41.8% vs. 38.7%, p<0.001). No significant differences were observed in dyslipidemia (17.6% vs. 16.7%, p=0.165), cachexia (4.3% vs. 4.6%, p=0.396), or palliative care utilization (13.0% vs. 13.5%, p=0.413). Conclusions: Women in the lowest income quartile comprise the majority of cervical cancer hospitalizations and face disproportionately higher rates of modifiable risk factors and comorbidities. Targeted interventions addressing screening access, preventive care, and comorbidity management in low-income populations are essential to reduce health disparities in cervical cancer.