Demographics and outcomes of cancer patients on Medicaid versus private insurance admitted to the hospital in a national sample.

Abstract

e13823 Background: Cancer is the second leading cause of death in the United States and one of the leading causes of hospital admissions and disability in the United States. There are also reports of rising incidence of cancer in younger population and rising costs of cancer care. We undertook this study to understand the differences in outcomes in patients with cancer admitted to the hospital on Medicaid versus Private insurance using a national sample. Methods: Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) was queried to identify all admissions in adult patients < 65 years old with cancer between 2016-2021. The patients on Medicaid and Private insurance were identified from this sample and compared for socio-demographic differences, medical comorbidities, all-cause mortality, mean length of stay (LOS) and mean total hospital charges (THC). Statistics were performed using the t-test, univariate and multinomial logistic regression. Results: Results: A total of 5,478,819 admissions occurred in patients with cancer of which 1,284,380 were on Medicaid while 2,843,950 were on Private Insurance. The Medicaid patients were significantly younger (50.9 vs 52.9 years, p < 0.001), more women (50.4% vs 49.6%, p < 0.0001) and more likely to be Black (22.7 vs 11.3%), Hispanic (18.1 vs 8.6%) and less likely to be White (50.4 vs 71.9), all p < 0.0001. Medicaid patients were more likely to be treated at rural and urban non-teaching hospitals compared to Private Insurance (19.2 vs 17.2%, p < 0.0001) and were two times more likely to be from lowest quartile income zip codes (40.2% vs 20.1%, < 0.0001). Medicaid patients also had a higher Charlson Comorbidity index with 75% having index of 3 or higher compared to 64% for Private Insurance (p < 0.0001). Patients on Medicaid had a high mean LOS (7.1 vs 5.9 days, p < 0.0001) and total charges ($87,470 vs $85,163, p < 0.0001) both of which remained significant after adjustment for all demographics and comorbidities. There were more deaths in Medicaid group (5.1% vs 4.2%, p < 0.0001) that also remained significant after adjustment for demographics and comorbid conditions including hypertension, diabetes, COPD, CKD, dialysis dependence, dyslipidemia, heart failure and obesity. Conclusions: Medicaid shoulders a significantly larger burden of sicker, poorer and younger cancer patients compared to Private Insurance. Such patients have higher cost of care and poorer outcomes when admitted to the hospital. More studies are needed to see why cancer patients on Medicaid have poorer outcomes and if they require more supportive services to improve their cancer outcomes.