Association of patient age and insurance status with in-hospital mortality for patients with lung cancer.

Abstract

e13669 Background: In 2022, the National Cancer Institute estimated that more than 240,000 individuals will be diagnosed with lung cancer. Furthermore, over 130,000 patients will die. To help minimize this death rate, it is important to identify death risk factors. Methods: We utilized the 2006-2012 Nationwide Emergency Department Sample to identify risk risk factors for death in lung cancer patients. A multivariate logistic regression was used to identify patient and hospital characteristics that were significantly associated with a higher chance of in-hospital death. The top 20 primary diagnoses of these patients were included in the analysis to take into account the reason to visit the ED. A p-value less than 0.05 was considered significant. Results: During this time period, 1,344,817 lung cancer patients presented to the emergency departments (ED) across the US. The majority of patients at least 70 years old (50.8%), male (51.1%), Medicare beneficiaries (67.5%), of the lowest income quartile (28.1%), living in the South (40.3%), presented to non-trauma hospitals (54.3%), and presented to metropolitan non-teaching hospitals (43.3%). Out of the 1,344,817 lung cancer patients that presented to the ED, 6.1% died in the hospital. The primary diagnoses associated with increased mortality are the following: respiratory failure (odds ratio (OR): 9.05, 95% confidence interval (CI): 8.47-9.67, p < 0.001), septicemia (OR: 8.46, 95% CI: 7.98-8.97,p < 0.001), acute cerebrovascular disease (OR: 3.04, 95% CI: 2.71-3.35,p < 0.001), secondary malignancy (OR: 2.00, 95% CI: 1.88-2.13,p < 0.001), pulmonary heart disease (OR: 1.97, 95% CI: 1.75-2.20,p < 0.001), and pneumonia (OR: 1.90, 95% CI: 1.80-2.01, p < 0.001). Patients at least 70 years old (OR: 3.09, 95% CI: 1.72-5.53, p < 0.001), males (OR: 1.28, 95% CI: 1.24-1.32,p < 0.001), and uninsured patients (OR: 1.29, 95% CI: 1.15-1.46, p < 0.001) are patient groups at higher risk for in-hospital mortality. 5 primary diagnoses associated with decreased risk of death are the following: fluid/electrolyte disorder (OR: 0.81, 95% CI:0.70-0.93), p = 0.003), central nervous system disease (OR: 0.76, 95% CI: 0.640.91, p = 0.002), arrhythmia (OR: 0.74, 0.65-0.83, p < 0.001), anemia (OR:0.68, 95% CI: 0.55-0.83, < 0.001), complication related to previous surgery of medical therapy (OR:0.64, 95% CI:0.51-0.80, < 0.001), and chronic obstructive pulmonary disease (OR: 0.45, 95% CI: 0.39-0.62, p < 0.001). Conclusions: Older, uninsured, and male lung cancer patients are at high risk for in-hospital mortality. Patients presenting to the ED with respiratory failure and septicemia are at the highest risk for mortality.