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Racial Inequality in Pancreatic Cancer Healthcare: A Cost Analysis of New York State Patients
Sonia Bharel*2, Juan Carlos Bucobo2, Jonathan M. Buscaglia2, Ellen Li2, Purvi Parikh2, Aaron Sasson2, Mark A. Talamini2, Rebecca Nelson1, Joseph Kim2
1City of Hope, Duarte, CA; 2Stony Brook University Hospital, Stony Brook, NY
Objective: Pancreatic cancer can be a rapidly fatal disease. Despite uniformly poor survival, pancreatic cancer is not exempt from racial disparities in outcomes. Here, we examined hospital admissions to identify potential disparities between white and black pancreatic cancer patients.
Methods: All patients hospitalized with diagnosis of pancreatic adenocarcinoma between the years 2009-2013 from all New York State (NYS) facilities were assessed using the Statewide Planning and Research Cooperative System (SPARCS) database. This database contains patient data regarding inpatient hospital stays, ambulatory surgeries, and emergency department admissions. Comparisons were made between white and black patients with hospital admissions for pancreatic cancer.
Results: During the study period 11,370 patients (white, n=9,297; and black, n=2,073) from 201 NYS facilities with pancreatic cancer were included in the analysis. In comparison, blacks were younger, had longer hospital stays (mean, 8 vs 7 days), increased medical treatment (77.6% vs 64.8%), decreased surgical treatment (22.4% vs 35.2%), and increased emergency admissions (69.9% vs 51.7%) (all p<0.0001). Importantly, blacks had an increased all-cause mortality rate during hospitalization (20.1% vs 15.3%) (p<0.0001). Additionally, overall costs were significantly higher for blacks than whites (mean, ,163 vs ,742), resulting in an expenditure gap of ,197,250. Multivariate analysis revealed that longer inpatient stay and higher emergency admission contributed to the higher overall costs of blacks.
Conclusions: Compared to white patients, black patients with pancreatic cancer are more likely to have both increased emergency room admissions and longer hospital stays, while incurring higher overall healthcare costs. Although survival for pancreatic cancer may remain poor, interventions to decrease emergency room care and lower length of stay may improve quality of life and reduce costs for blacks with pancreatic cancer.
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