1236 Hospitals With Low-Medium Safety-Net Burden Incur the Highest Costs for Hospitalizations of U.S. Adults With Gastric Cancer

Abstract

INTRODUCTION: Although gastric cancer is relatively rare in the U.S., diagnosis at an earlier stage is associated with improved treatment options and higher overall survival. Safety-net hospitals continue to bear the brunt of recent major healthcare coverage reforms. We aim to evaluate factors, including safety-net burden (SNB), associated with in-hospital mortality and inpatient costs among hospitalized adults with gastric cancer. METHODS: Using the 2012-2014 National Inpatient Sample, adult hospitalizations with gastric cancer were identified using ICD-9 codes. Hospital SNB was defined as percentage of hospitalizations with Medicaid or uninsured payer status per hospital, and categorized into three groups: none, low-medium, and high. Between-group comparisons used chi-squared testing. Adjusted logistic regression was used to analyze predictors of in-hospital mortality. Multivariate linear regression was performed after logarithmic transformation of the outcome to identify factors associated with mean hospitalization costs; inflation adjusted to 2014 US dollars. Coefficients were exponentiated to yield percentage change associated with each predictor. RESULTS: Among 26,417 adults with gastric cancer (mean age 65.7 ± 14 years, 36.3% female, 55.3% non-Hispanic White), 48.6% were low-medium burden, and 22.4% were hospitalized in high SNB hospitals. Overall in-hospital mortality was 7%, with no significant differences by hospital SNB. Compared to men with gastric cancer, women had significantly lower odds of in-hospital mortality (7.3% vs. 6.4%; OR 0.81, 95% CI 0.73-0.89, P < 0.001), and patients who received surgery (vs. no surgery) were less likely to experience in-hospital deaths (3.4% vs. 7.7%; OR 0.49, 95% CI 0.41-0.58, P < 0.001). Total estimated hospitalization costs were $2.5 billion. On regression, mean inpatient costs were significantly higher for hospitalizations at a low-medium SNB hospital (vs. no burden) (4.6% higher, 95% CI 0.6-8.7%, P = 0.02). Patients who underwent partial/total gastrectomy (vs. no surgery) incurred greater costs (183% higher, 95% CI 176-190%, P < 0.001). CONCLUSION: There were no significant differences in rates of in-hospital mortality by SNB, however, low-medium SNB hospitals bore majority of the economic burden. Men with gastric cancer were more likely to die during hospitalization. While those who received partial/total gastrectomy incurred higher costs, in-hospital mortality was lower compared to those who did not receive surgery.