DISPARITY IN HEALTHCARE COSTS AMONG AFRICAN AMERICANS AND CAUCASIANS WITH TRALI COMPLICATED WITH UNDERLYING CKD

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: In 2016, the US spent 17.8% of its gross domestic product on healthcare, much higher compared to other countries. Despite this, health care costs continue to rise without much improvements in outcomes. Transfusion related acute lung injury (TRALI) is a type of blood transfusion adverse reaction that usually develops within 6 hours of transfusion and is a leading cause of morbidity and mortality [2]. It occurs due to the presence of donors antibodies recognizing leukocyte antigens in the recipient. Millions of blood transfusions take place in the US within hospitalized patients with underlying co-morbidities including chronic kidney disease (CKD), comprising 0.9%-6.8% of all admitted patients in the intensive care unit. Patients with CKD are more likely to require transfusions given decreased erythropoietin synthesis. To our knowledge, there is insufficient evidence looking at the racial differences between healthcare costs for patients with TRALI. We propose to look at healthcare cost differences between Caucasians and African Americans admitted for TRALI with underlying CKD. METHODS: The National Inpatient Sample (NIS) was used to query the prevalence of TRALI with the International Classification of Disease (ICD) Code 518.7 in all discharge diagnoses. ICD codes of 585.x were used to identify the various stages of CKD and those without CKD. Comparisons in subgroup analysis were also looked at with patients with CKD vs without. Analysis was carried out via the software SAS using multivariate analysis. Variables that were looked at included age, length of stay (LOS), mortality, number of procedures, mean charges, mean income quartile by zip code. RESULTS: During the years of 2003 and 2014 there were a total of 9,844 hospitalizations for TRALI in the United States. Of these, 8241 were of Caucasian descent and 1603 were of African American. Results for Caucasians vs African Americans, respectively, are as follows: average age 64 years vs 50 years (p =0.5); LOS 15.37 days vs 17.19 days (p = 0.95); mortality 19.71% vs 15.88%, (p = 0.79); number of procedures 6.53 vs 6.57 (p = 0.74); total charges $191,320 vs $215, 550 (p = < 0.05). CONCLUSIONS: Healthcare costs and disparities are a major concern in the current practice of medicine despite large amount of health care spending in the United States. In the data that was analyzed there was no mortality difference between Caucasians and African Americans with TRALI. Additionally, age, length of stay and number of procedures were of no statistical significance. Despite no major differences, African Americans paid $24,000 more for the admission in spite of making less income based off the income quartile. CLINICAL IMPLICATIONS: Further research is needed to further elucidate the discrepancy of cost and racial healthcare disparities in patients who experience TRALI. DISCLOSURES: No relevant relationships by Nikhila Kethireddy, source=Web Response No relevant relationships by Shashank Sama, source=Web Response No relevant relationships by Varun Tandon, source=Web Response