Who receives CAR-T therapy? A national examination of racial and ethnic differences in hospitalized adults.

Abstract

e18576 Background: CAR-T therapy has improved outcomes in hematologic malignancies but remains resource-intensive and largely confined to academic centers, raising concerns about equitable access. Given its distinctive toxicity profile, assessing real-world racial and ethnic disparities in CAR-T utilization and outcomes is essential. We evaluated racial and ethnic differences among hospitalized U.S. adults receiving CAR-T therapy using a nationally representative inpatient database, focusing on demographics, hospital utilization, treatment-related complications, and in-hospital outcomes. Methods: A retrospective cross-sectional study was conducted using the 2019–2023 National Inpatient Sample (NIS) database. Adult patients hospitalized (≥18 years) who received CAR-T therapy were identified using ICD-10 procedure codes. Patients were categorized by race/ethnicity as white, black, and hispanic, and outcomes were compared across groups. Univariable and multivariable logistic regression was performed to evaluate associations between race/ethnicity and mortality, age, gender, length of stay, hospital cost, and clinical outcomes. Results: Among 10,690 hospitalized adult CAR-T recipients, most were male (61%), privately insured (47%), treated at large (75%) and teaching hospitals (99%). Most recipients were White (74%), followed by Hispanic (11%) and Black (7%). Compared to White recipients, Black (mean age 58 years; Coef −2.9; P<0.05) and Hispanic recipients (Coef −12.5; P<0.001) were younger, while White patients were older (Coef 3.7; P<0.001). Hispanic patients had longer length of stay than White patients (19.1 vs 16.9 days; Coef 2.1; P<0.05). After multivariable adjustment, Black patients had increased cardiovascular complications (OR 1.8; P<0.05), whereas Hispanic patients had lower odds (12% vs 25%; OR 0.40; P<0.001). CRS (34% vs 47%; OR 0.57; P<0.001) and ICANS (4% vs 14%; OR 0.25; P<0.001) were lower in Hispanic than White patients, while TLS was more common in Hispanic patients (9% vs 5%; OR 2.0; P<0.05). No racial differences were observed in in-hospital mortality, sex distribution, or hospital costs. Conclusions: This study highlights significant racial and ethnic heterogeneity exists in CAR-T–associated toxicities despite similar in-hospital mortality and costs. These findings suggest differences in comorbidity burden, disease biology, or care delivery processes. Prospective studies should prioritize equity-focused risk stratification, standardized toxicity monitoring, and longitudinal outcomes to mitigate disparities in CAR-T care.