Racial and payer-based disparities in inpatient resource utilization and mortality among patients hospitalized with head and neck cancer in the United States, 2018 to 2022.

Abstract

11099 Background: Inpatient hospitalizations for head and neck cancer (HNC) reflect advanced disease, treatment-related complications, and high healthcare utilization. National data on racial and payer-based disparities in inpatient length of stay (LOS), costs, and mortality remain limited. Methods: A survey-weighted cohort analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (NIS), 2018 to 2022, was performed. Hospitalizations with a principal diagnosis of HNC were identified using ICD-10-CM codes C00 to C06, C07 to C08, C09 to C14, C30 to C32, and C76.0; thyroid cancer (C73) was excluded. Outcomes included in-hospital mortality, LOS, and hospitalization cost. Survey-weighted mean LOS and cost were estimated by race and primary payer. A survey-weighted multivariable logistic regression evaluated predictors of in-hospital mortality, adjusting for age, sex, year, anatomic subsite, race, payer, ZIP-code income quartile, elective admission status, and hospital teaching and location characteristics. Results: The weighted national estimate included 166,020 inpatient HNC hospitalizations (95% CI 158,702 to 173,338). Mean LOS ranged from 7.43 days among White patients (95% CI 7.29 to 7.56) to 10.21 days among Black patients (95% CI 9.81 to 10.60), with intermediate LOS among Hispanic (9.22 days), Asian or Pacific Islander (8.41 days), Native American (8.86 days), and Other race groups (8.25 days). Mean hospitalization costs were highest among Asian or Pacific Islander patients ($46,577, 95% CI $41,648 to $51,506) and Hispanic patients ($42,384, 95% CI $39,129 to $45,640), compared with White patients ($36,887, 95% CI $35,197 to $38,577). Medicaid hospitalizations had the longest LOS (10.58 days, 95% CI 10.16 to 10.99) and high costs ($42,217, 95% CI $40,126 to $44,308), whereas privately insured hospitalizations had the shortest LOS (6.54 days, 95% CI 6.37 to 6.72). In adjusted analyses, mortality increased with age (OR 1.02 per year, 95% CI 1.01 to 1.03). Asian or Pacific Islander (OR 1.51, 95% CI 1.07 to 2.13) and Other race patients (OR 1.59, 95% CI 1.09 to 2.32) had higher mortality than White patients. Non-Medicare other insurance was associated with higher mortality than Medicare (OR 2.56, 95% CI 1.89 to 3.46). Elective admissions (OR 0.21, 95% CI 0.16 to 0.27) and care at urban teaching hospitals (OR 0.34, 95% CI 0.25 to 0.47) were associated with lower mortality. Conclusions: Racial and payer-based disparities persist in inpatient LOS, costs, and mortality among patients hospitalized with HNC. Black and Medicaid-insured patients experience longer hospitalizations, while Asian or Pacific Islander and Hispanic patients incur higher costs. Persistent mortality differences after adjustment highlight structural and health-system contributors and support targeted equity-focused interventions.