Racial differences of iron deficiency anemia in gastric cancer.

Abstract

e15564 Background: One of the six domains of health care quality identified by the Institute of Medicine in 2001 was equitable care.1 While disparities in cancer are often expressed in terms of mortality, comorbidities such as iron deficiency anemia (IDA) that can be caused by less comprehensive or less timely treatment of gastrointestinal malignancies also impact quality of life and may be considered as a metric of equitable care. Methods: Using data from the Healthcare Cost and Utilization Project (HCUP), total numbers of U.S. admissions with gastric cancer listed as primary diagnosis were recorded for each year between 1999-2014. The subset of these numbers with IDA listed as a secondary diagnosis were recorded to derive a prevalence of IDA within this gastric cancer population. The relative rate of African American and Hispanic IDA prevalence were compared to Caucasians for each year. Within each ethnic subset, cost, length of stay, and inpatient mortality were compared. Results: The relative rate of iron deficiency in gastric cancer for African Americans versus Caucasians was 1.745 and for Hispanics versus Caucasians was 1.665. Hospital cost by ethnic group: Caucasians $55,359, African Americans $62,020, Hispanics $83,914. Length of stay in days by ethnic group: Caucasians 9.13, African Americans 10.12, Hispanics 10.17. Inpatient mortality by ethnic group: Caucasians 4.51%, African Americans 4.02%, Hispanics 2.29%. All values were significant (p < 0.05). Conclusions: African American and Hispanic populations are at increased risk of iron deficiency anemia in the setting of gastric cancer as compared to Caucasians. This was associated with increased cost and length of stay to a lesser degree. Surprisingly, Caucasians still demonstrated the highest mortality rate, followed by African Americans and Hispanics. This suggests that though ethnic disparities are still evident as of 2014 they may not accurately reflect mortality but still continue to impact morbidity. As this comorbidity impacts quality of life, it may be a target for future metrics or interventions.