Racial and insurance-based differences in nutritional anemia among hospitalized patients with head and neck cancer: A national analysis, 2016–2022.

Abstract

e23200 Background: Nutritional compromise is a common and clinically important concern among patients with head and neck cancer, driven by tumor-related dysphagia, treatment-associated toxicity, and chronic inflammation. Nutritional anemia reflects both nutritional and physiologic vulnerability, yet its distribution across sociodemographic groups at the time of hospitalization remains poorly characterized. We aimed to evaluate sociodemographic factors, including race and insurance status, associated with nutritional anemia among adults hospitalized with head and neck cancer. Methods: We performed a retrospective cohort analysis of the National Inpatient Sample (NIS) from 2016 to 2022, identifying adult hospitalizations with a principal diagnosis of head and neck cancer and nutritional anemia using ICD-10-CM codes. Associations among nutritional anemia, sociodemographics and hospital characteristics were evaluated using multivariable logistic regression. Survey weights were applied to generate national estimates. Results: An estimated 189,320 hospitalizations for head and neck cancer were identified, of which 1.2 percent were complicated by nutritional anemia. The prevalence of nutritional anemia varied by race and insurance status. After multivariable adjustment, Black race and Medicaid insurance were associated with higher odds of nutritional anemia compared with White race and private insurance, respectively. Patients from lower neighborhood income quartiles also had higher odds of nutritional anemia. In contrast, treatment at large or teaching hospitals was associated with lower odds of nutritional anemia. Age and sex were not independently associated with nutritional anemia after adjustment. Conclusions: Among hospitalized patients with head and neck cancer, nutritional anemia is not evenly distributed across sociodemographic groups. Racial and insurance-based differences persist after accounting for comorbidity burden and hospital characteristics, suggesting that nutritional vulnerability at hospital presentation may reflect broader structural and access-related factors. These findings support the need for earlier and more targeted nutritional assessment in populations at increased risk.