Racial comparison of outcomes and costs of inpatient neutropenic patients: A multicenter evaluation

Abstract

6042 Background: Racial disparities have been reported in the care and outcome of cancer patients. Many reports state that minority patients receive worse care and have poorer outcomes compared to Caucasians. Neutropenia is a common complication of cancer treatment leading to dose reductions, infectious complications, and potential hospitalization. We evaluated whether race would influence the costs and outcomes of inpatient neutropenic cancer patients in a multicenter study. Methods: Patient data from a large health care system in the Midsouth were analyzed between 10/01/02 to 09/30/03. Demographic data, health, and economic outcomes were extracted from a health claims database. Patients with a diagnosis code for neutropenia (Medicode, DRG Expert) were selected. A Student’s t-test and Chi Squared were used for statistical analyses; p-value < 0.05 was considered significant. Results: 360 patients (0.37% of all admits) had a diagnosis of neutropenia in the 16 hospital system. 244 patients (67.8%) were Caucasian and the remaining 116 were minorities (94.8% were African Americans). Minority patients were more likely to be younger (53.68 vs. 61.16 years; p=0.0002) and have no insurance, receive Medicaid assistance, or have a commercial HMO or PPO. Caucasian patients were more likely to be on Medicare (p=0.00004 for all payer analyses). Despite these age and insurance differences, both groups had similar case mix indices (1.56 vs. 1.65), total hospital costs ($12,988 vs. $12,540), medication costs ($2,821 vs. $2,541), laboratory costs ($1,199 vs. $1,204), and length of stay (9.85 vs. 9.99 days); Caucasian vs. minority patients, respectively (P=NS). Discharge status was also not significantly different, with similar proportions of patients discharged home, to hospice, expiring, or receiving additional care. Conclusions: Costs and outcomes did not differ between Caucasians and minority neutropenic cancer patients in this large, multicenter hospital system. Due to the escalating reports of racial disparities in cancer care, these results are encouraging. No significant financial relationships to disclose.