Predictors of mortality in hospitalized patients with metastatic non-small cell lung cancer (mNSCLC) with or without idiopathic pulmonary fibrosis (IPF).

Abstract

e20703 Background: mNSCLC is associated with poor survival, with 5-year rates < 15%. Concurrent IPF further worsens prognosis and increases the risk of hospitalization due to respiratory complications. However, factors associated with in-hospital mortality among patients with mNSCLC, especially those with IPF, remain poorly understood. We examined patient- and hospital-level predictors of in-hospital mortality among patients with mNSCLC with and without IPF. Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS) from 2017 to 2021. Adult (≥18 years) inpatient hospitalizations with a diagnosis mNSCLC were identified using ICD-10 CM codes and stratified by the presence of a concurrent diagnosis of IPF. Descriptive analyses and standard tests of association were performed. Multivariable logistic regression models were used to examine the factors associated with in-hospital mortality among patients with mNSCLC, stratified by IPF status. Results: Of 1,564,000 hospitalizations with mNSCLC, 13.6% had a concurrent diagnosis of IPF. In-hospital mortality was higher among patients with IPF compared to those without IPF (58% vs 42%, p < 0.001). Among patients with IPF, being non-Hispanic Black (NHB) (Adjusted odds ratio [AOR] 1.80, 95% CI 1.20–2.60) or Hispanic (AOR 1.60, 95% CI 1.20–3.10) was associated with higher odds of in-hospital mortality compared to being non-Hispanic White (NHW). While age ≥65 years was associated with higher mortality odds relative to age < 65 (AOR 2.25, 95% CI 1.40–3.79), having private insurance was associated with lower odds compared to being on Medicare (AOR 0.43, 95% CI 0.35–0.78). Patients who received care at urban teaching hospitals had lower risk of mortality than those treated at rural hospitals (AOR 0.34, 95% CI 0.20–0.80). Notably, those with acute respiratory failure (ARF) were more likely to have in-hospital mortality than patients without ARF (AOR 1.86, 95% CI 1.24–2.85). However, among patients without IPF, NHB race was associated with lower odds of in-hospital mortality compared to NHW race (AOR 0.23, 95% CI 0.10–0.60). Across both cohorts, prolonged length of stay ( > 5 days), endotracheal intubation, and higher comorbidity burden were associated with increased mortality. Conclusions: Our findings demonstrate that hospitalized patients with mNSCLC and concurrent IPF experience high in-hospital mortality, with notable disparities identified by age, race and ethnicity, insurance status and hospital type. The differences in mortality outcomes by care setting suggest that health system-level factors may influence survival in this vulnerable population. Further investigation into the drivers of these disparities is needed to shape clinical interventions and inform policy decisions to improve outcomes.