eP530 - Income- and Race-Based Healthcare Utilization Disparities in Rectal Cancer in the State of New Jersey: An HCUP Analysis

ePoster Presenter(s)

• 

  Alexander J. Rossi, MD

  General Surgery Resident
  Rutgers Robert Wood Johnson Medical School
  Rutgers Robert Wood Johnson Medical School
  New Brunswick, NJ, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Kayla N. Laraia

  Medical Student
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, NJ, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• SA

  Sarfraz R. Akmal, n/a

  Medical Student
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• EK

  Emily Kolodka, M.D.

  General Surgery Resident
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.
• BS

  Brendan Scully, MD

  Assistant Professor
  Rutgers Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.
• LL

  Leonard Lee, M.D.

  Chairman, Department of Surgery
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.
• KD

  Kristen Donohue, MD

  Assistant Professor of Surgery
  Rutgers RWJMS
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.
• DF

  Daniel Feingold, MD

  Professor of Surgery
  Rutgers University
  New Brunswick, New Jersey, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• NM

  Nell Maloney Patel, M.D.

  Program Director, General Surgery Residency
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.

Purpose/Background: Associations between race and rectal cancer incidence have been well described in the literature. Such disparities have been attributed to a multitude of complex socioeconomic and social determinants of health, including wealth, lifestyle factors, access to care, and screening and preventative health. Previous studies have investigated these associations on the national or single institution level, however, there is little investigation into the association between race and rectal cancer care in distinct geographic regions. We sought to describe the status of rectal cancer healthcare utilization within the state of New Jersey as regards racial and economic disparities, within the lens of inpatient stays.Methods/Interventions: A query of the New Jersey State Inpatient database from 2016-2019 was completed for patients with rectal cancer (ICD-10-CM C20X). Patient demographics, including age, sex, race, zip-code-based income quartile, Charlson Comorbidity Index and primary insurance were collected. Outcomes included length of hospital stay, total hospital charges, 7-day readmission, in-hospital mortality, pelvic abscesses, ileostomy, and colostomy creation rates. Characteristics and outcomes were compared using T-tests and Chi-squared tests. P < 0.05 was considered statistically significant.Results/Outcomes: A total of 4344 patients were included, 2893 white and 1451 non-white, of which 38.4% were Black, 34.5% were non-white Hispanic, and 13.8% were Asian/Pacific Islander. Of the non-white population, 73.4% identified English as their primary language. The non-white population was significantly younger (mean 63) and poorer (43.4% in the bottom 2 income quartiles), but less comorbid (CCI >4 in 36.6%). The non-White charges were also predominantly paid by governmental or charity/self-pay sources (83%), whereas White patients had private insurance as the most common primary payer (43.2%). Non-white patients had significantly longer hospital stays (7.7 vs. 6.8 days, p = 0.0005), higher charges by approx. 20% (p < 0.001), and higher 7-day readmission rates (9% vs. 7%). There were no significant differences in mortality rates, ileostomy creation rates, or pelvic abscess rates. Colostomies were created significantly more often in the non-white population (15.4% vs. 12.1%).Conclusion/

Discussion: This state-wide population-level data reveals that non-white patients with rectal cancer are younger and less comorbid, yet have longer hospital stays, higher hospital costs, and higher readmission rates. They also had higher rates of colostomy creation, which reveals a likely inequity in the rates of primary anastomosis. Lack of preventative healthcare and screening may be leading to earlier onset cancers, as well as more advanced disease states requiring primary diversion, in addition to a greater burden of undiagnosed comorbidities at admission, which may be contributing to the higher costs and lengths of stay in this population.Table 1. Baseline Characteristics and OutcomesTable 1. Baseline Characteristics and Outcomes