Inpatient outcomes of breast cancer hospitalizations in the northeastern vs western United States.

Abstract

11181 Background: Regional disparities in healthcare resources and outcomes are well-documented in the U.S., yet little is known about how they impact inpatient outcomes in breast cancer (BC) patients. The Northeastern (NE) region has the highest incidence and prevalence of BC, along with a greater concentration of academic cancer centers, while the Western (W) region has the lowest rates. This study compares both in-hospital and discharge outcomes of BC patients between these regions to explore how these variations affect inpatient outcomes. Methods: A cross-sectional analysis was done using the National Inpatient Sample database (2016–2020) using STATA 17.0 software. NE was taken as reference. Baseline characteristics and outcomes were compared among NE and W using chi-square tests and survey-weighted multivariate logistic regressions, after adjusting for confounders. Results: Among 855,494 BC hospitalizations, 22% were from the NE and 19% were from the W. Patients in W were younger, with 18% aged <50 years compared to 16% in NE (p < 0.001). 38% of NE patients were from high-income backgrounds, compared to 32% in W, while 16% of both NE and W patients were from the lowest income group (p < 0.001) suggesting significant income disparities in NE. 85% of NE patients were treated at teaching hospitals compared to 70% in W. However, in NE, only 46% sought care at large bed size hospitals compared to 58% in W (all p < 0.001). NE patients had longer hospital stays (>7 days: 22% vs 19%, p < 0.001) and incurred higher costs. Additionally, patients in the W had significantly lower odds of in-hospital mortality and discharges to skilled nursing facilities (NH) compared to NE (Table). Conclusions: We identified significant regional differences in BC hospitalization outcomes. W had lower mortality and lesser NH discharges, possibly due to a younger population and differences in post-acute care. In contrast, older demographics and socioeconomic factors in the NE may explain higher costs and mortality. Despite more academic centers in the NE, outcomes were not better. These findings highlight the need for region-specific strategies to improve BC care. Future research should focus on the drivers of these disparities and develop targeted interventions. Outcomes in BC hospitalizations in W compared to NE. Outcomes in W* Adjusted Odds Ratio** 95% Confidence Interval p-value Mortality 0.57 0.54-0.61 <0.001 Length of Stay 0.86 0.82-0.90 <0.001 NH Discharge 0.90 0.82-0.99 0.043 Total Hospital Charges ($) 16318 *** 12978-19657 <0.001 *Reference: NE. **Adjusted for confounders. ***Beta-coefficient.