National disparities in outcomes among hospitalizations for myelodysplastic syndromes complicated by sepsis: The impact of insurance, hospital type, and geographic region.

Abstract

e18583 Background: Prior studies show that sepsis outcomes vary by insurance, hospital type, and geographic location; however, whether these disparities apply to patients with myelodysplastic syndromes (MDS) remains unclear. Methods: We used the Nationwide Inpatient Sample (2015–2017) and identified hospitalizations with MDS and sepsis using ICD-9/10 codes. Survey-weighted univariate and multivariable logistic regression evaluated in-hospital mortality and complications (AKI, shock, ARDS, DIC, mechanical ventilation). Mean length of stay (LOS) and hospital charges were additionally calculated. Results: Among 10,357 hospitalizations (mean age 70.2 years; 43.7% female), females had lower odds of AKI (OR 0.78) but similar mortality (0.98). Hispanic ethnicity was associated with lower mortality (0.80) and ARDS (0.80), while Black race had higher odds of mechanical ventilation (2.47). Urban teaching hospitals had higher mortality (1.39) and complications, including shock (1.91), AKI (1.22), ARDS (1.22), and ventilation (2.46); urban non-teaching hospitals showed similar increases. Private insurance was associated with higher mortality (1.57), whereas Medicaid was associated with lower odds of complications. Mean LOS was 9.9 days and longer among privately insured and Medicaid patients (~14 days). Charges were higher at urban teaching versus rural hospitals ($75,677 vs $36,813) and highest in the West ($86,361). Conclusions: Hospital type and insurance were more strongly associated with mortality, complications, and costs than demographic factors, highlighting the influence of system-level disparities in MDS-related sepsis care. Baseline characteristics and multivariate analysis. Outcome / MetricN = 10357 Urban teaching Urban non-teaching Private Medicaid Female Black Hispanic South West Mortality OR 1.39 1.16 1.57 0.88 0.98 1.08 0.80 1.01 0.95 AKI OR 1.22 1.07 1.01 0.75 0.78 1.07 0.84 1.13 1.17 Septic Shock OR 1.91 1.69 1.03 0.73 0.92 0.93 1.04 1.04 0.92 Mechanical vent OR 2.46 2.35 0.89 0.74 0.90 2.47 1.06 0.99 0.92 ARDS OR 1.22 1.10 0.93 0.72 0.90 1.02 0.80 1.04 1.20 Mean LOS (days) 11.9 9.1 14.0 14.6 — 10.6 11.2 — — Mean charges ($) 75,677 65,599 73,468 60,932 66,490 — — 65,390 86,361 Reference group Rural Rural Medicare Medicare Male White White Northeast Northeast Adjusted odds ratios from survey-weighted multivariable logistic regression. Reference groups: male, White race, rural hospitals, Medicare, Northeast.