Insurance, hospital, and racial disparities in surgical treatment and mortality among patients with neuroendocrine tumors: A national analysis.

Abstract

4184 Background: Neuroendocrine tumors (NETs) are the second most common gastrointestinal malignancy with increasing incidence. Surgical resection remains curative, yet population-level disparities data are lacking. We examined insurance, hospital, and racial disparities in NET surgical treatment and outcomes. Methods: Using the National Inpatient Sample (2019-2022), we identified NET hospitalizations (ICD-10: C7A, C7B, C25.4, C4A). Outcomes were surgical resection and in-hospital mortality. Multivariable logistic regression estimated adjusted odds ratios (aOR) by insurance, hospital type, and race, controlling for demographics, tumor site, and metastatic status. Results: Among 198,955 NET hospitalizations (mean age 64.9 years; 52.7% metastatic), surgical resection was 35.3% and mortality 5.2%. Medicaid (aOR 0.58, 0.56-0.60) and Medicare (aOR 0.64, 0.63-0.66) patients had significantly lower surgery odds versus private insurance (p<0.001). In localized disease, surgery rates were 58.9% (Private) vs 36.9% (Medicare). Rural patients had 50% lower surgery odds (aOR 0.50, 0.48-0.53) and 47% higher mortality (aOR 1.47, 1.34-1.61) versus urban teaching hospitals. Black patients had 19% lower surgery odds (aOR 0.81, 0.78-0.83) and 18% higher mortality (aOR 1.18, 1.11-1.25) versus White patients. Conclusions: This largest national NET analysis reveals profound multilevel disparities: Medicaid/Medicare patients are 36-42% less likely to receive surgery, rural patients face 50% lower surgical access with 47% higher mortality, and Black patients experience significant treatment and survival inequities. Findings support targeted interventions including insurance coverage expansion, rural referral networks, and equity-focused initiatives. Multilevel disparities in surgical resection and mortality among patients with neuroendocrine tumors. Disparity Type Comparison N Surgery Rate Mortality aOR (Surgery) aOR (Mortality) 95% CI P-value Key Finding Overall Cohort — 198,955 35.3% 5.2% — — — — Mean age 64.9y; 52.7% metastatic INSURANCE DISPARITIES Insurance Medicare vs Private — 29.9% vs 45.3% — 0.64 0.90 0.63-0.66 / 0.84-0.95 <0.001 36% lower surgery odds Insurance Medicaid vs Private — — — 0.58 1.26 0.56-0.60 / 1.16-1.37 <0.001 42% lower surgery; 26% higher mortality HOSPITAL DISPARITIES Hospital Rural vs Urban Teaching — — 7.0% vs 4.9% 0.50 1.47 0.48-0.53 / 1.34-1.61 <0.001 50% lower surgery; 47% higher mortality RACIAL DISPARITIES Race Black vs White — — — 0.81 1.18 0.78-0.83 / 1.11-1.25 <0.001 19% lower surgery; 18% higher mortality Localized NETs Private vs Medicare 87,100 58.9% vs 36.9% 1.7% vs 3.6% — — — — 22-point surgery gap