Unveiling inequities: Racial disparities in MACCE outcomes among esophageal cancer patients.

Abstract

e16165 Background: Esophageal cancer is a highly lethal malignancy with significant racial and ethnic disparities in clinical outcomes and healthcare utilization. Cardiovascular and cerebrovascular events, including myocardial infarction (MI), arrhythmias, and sudden cardiac arrest, add to the disease burden. This study uses the National Inpatient Sample (NIS) from 2016–2021 to investigate racial disparities in MACCE outcomes, mortality, and healthcare resource utilization among hospitalized esophageal cancer patients. Methods: A retrospective cohort analysis was performed using the NIS database to identify adult esophageal cancer patients. Demographic and clinical characteristics, including race, socioeconomic status, and comorbidities, were compared across racial groups. Primary outcomes included in-hospital mortality, MI, sudden cardiac arrest, stroke, and arrhythmia. Healthcare utilization metrics, including length of stay (LOS) and total charges, were also analyzed. Multivariable logistic regression models adjusted for potential confounders were used to assess racial disparities in these outcomes. Results: Among 229,963 esophageal cancer patients, the racial distribution included White (80.5%), Black (10.0%), Hispanic (6.2%), Asian or Pacific Islander (2.4%), Native American (0.5%), and Other (2.2%). Black (OR 1.148, p = 0.014) and Asian or Pacific Islander (OR 1.228, p = 0.038) patients had significantly higher odds of mortality compared to White patients. Black patients had a lower risk of MI (OR 0.72, p = 0.008) but were significantly more likely to experience sudden cardiac arrest (OR 2.206, p < 0.001). Hispanic (OR 1.398, p = 0.021) and Other racial groups (OR 1.688, p = 0.025) also had increased odds of sudden cardiac arrest. Atrial fibrillation was significantly less common in Black (OR 0.627, p < 0.001), Hispanic (OR 0.52, p < 0.001), and Asian or Pacific Islander (OR 0.476, p < 0.001) patients. Length of stay was significantly longer for Black (8.25 days), Hispanic (7.34 days), and Other (7.71 days) racial groups compared to White patients (6.79 days, p < 0.001). Hospital charges were highest among Hispanic ($107,531) and Asian or Pacific Islander ($109,164.6) patients compared to White patients ($84,753.53, p < 0.001). Conclusions: This study identifies significant racial disparities in esophageal cancer outcomes, with Black and Asian patients experiencing higher mortality and Black patients demonstrating an increased risk of sudden cardiac arrest. Differences in length of stay and hospital charges underscore healthcare inequities. These findings emphasize the need for targeted interventions to reduce cardiovascular risks and improve equitable healthcare access and outcomes for racial and ethnic minority populations with esophageal cancer.