Structural inequities in ovarian cancer care: A national study of hospital utilization, costs, and outcomes.

Abstract

e17607 Background: Racial disparities may affect the clinical outcomes in ovarian cancer. In this study we aimed to identify the racial disparities in United States hospital outcomes of patients with ovarian cancer. Methods: We performed a retrospective analysis of ovarian cancer-related hospital admissions using the 2022 National Inpatient Sample. Patients were stratified according to race into the following groups: White, African American, Hispanic, Asian or Pacific Islander, Native American, & Other. Results: There were 12,397 ovarian cancer patients admitted in 2022, out of which 68.41% were whites, 11.72% African-Americans, 11.63% Hispanics, 4.60% Asian or Pacific Islanders, 0.60% Native-American & 3.04% were included in the minor groups. White patients had the highest mean age (65 years), while Hispanic & Asian/Pacific Islander patients presented at a younger age (57 years). There was no statistical difference in mortality rates among the different racial group (p-value 0.31). Most ovarian cancer hospitalizations occurred at large hospitals and teaching institutions, with higher teaching-hospital utilization among African-American (88.2%), compared with White patients (83.1%). Socioeconomic disparities were observed, as African-American (43.3%) & Native American (41.4%) patients were overrepresented in the lowest median household income quartile, whereas Asian/Pacific Islander patients were more frequently in the highest quartiles (Quartile 3–4: 78.8%). Discharge to home was most common across all groups (52.1–65.1%), while White (11.9%) & African-American (10.8%) patients had higher rates of discharge to skilled nursing facilities. Insurance status differed significantly, with Medicaid coverage more common among African-American (18.9%), Hispanic (26.3%), & Native American patients (20.6%), while Medicare predominated among White patients (57.7%) ( p < 0.001). African-American & Native American patients experienced longer hospital stays (7.3 and 7.5 days, respectively) compared with White patients (5.7 days) (p < 0.001). Total hospitalization charges were significantly higher among Hispanic, Asian/Pacific Islander, Native American, & Other racial groups, with the highest costs observed in Asian/Pacific Islander patients ($112,699), compared with White patients ($81,546) (p < 0.01). Conclusions: This national analysis demonstrates clear & clinically meaningful racial disparities in ovarian cancer hospitalizations. Minority patients present at younger ages, experience greater healthcare utilization, incur substantially higher hospitalization costs, & are disproportionately cared for in large, teaching hospitals while residing in lower-income communities. Urgent, targeted policy and system-level interventions are needed to address socioeconomic barriers, optimize care delivery, & advance equity in ovarian cancer outcomes.