EP763 - Early-Onset Colorectal Cancer Disproportionately Affects Minority Hospitalizations: A 2022 National Inpatient Sample Analysis

Purpose/Background: Early-onset colorectal cancer (EOCRC, < 50 years) is rising. Using a national sample, we sought to investigate demographics of patients with EOCRC compared to that of standard-age colorectal cancer (SCRC, ≥50 years old) and relate demographics to short-term outcomes.

Methods/Interventions: We analyzed hospitalizations recorded in Healthcare Cost & Utilization Project - National Inpatient Sample (HCUP-NIS) for all colorectal cancer diagnoses (ICD-10 C18-C20) during 2022. Patient discharges were stratified into EOCRC and SCRC. We compared patient demographics (race, ethnicity, insurance, location), hospital characteristics (ownership, bed size, region), severity and comorbidity indices (All Patient Refined Diagnosis Related Groups (APR-DRG), Elixhauser), procedure type, and outcomes (length of stay (LOS), in-hospital mortality, disposition). Two-sided p< 0.001 flagged statistical significance given large sample size.

Results/Outcomes: Among 50,207 colorectal cancer hospitalizations, 6,126 (12.2%) were EOCRC. Race and ethnicity differed by age group (p < 0.001). Minorities were over-represented in EOCRC compared to SCRC (Hispanic 17.5% vs 9.57%, Black 15.2% vs 12.4%, Asian or Pacific Islander 5.55% vs 3.75%). EOCRC was less likely to be treated in rural hospitals compared to SCRC (4.0% vs 8.0%, p< 0.001)). Among urban patients, EOCRC was more likely than SCRC to be treated in a teaching hospital (84.5% vs 77.0%, p< 0.001) and in the Western states (22.9% vs 19.6%, p< 0.001). EOCRC had higher rates of sigmoid than did SCRC (9.32% vs 6.38%) and rectal (6.07% vs 4.20%) surgery and more ostomy creation (12.4% vs 9.46%), while SCRC more often underwent right-sided colon procedures (17.0% vs 9.64%). Overall, EOCRC discharges were more likely to be in lower disease severity and comorbidity quartiles (p < 0.001) and had shorter mean LOS (6.18 vs 6.85 days, p< 0.001). In-hospital mortality was lower in EOCRC (3.43%) vs SCRC (4.96%, p< 0.001), and routine disposition was more common (70.2% vs 51.5%, p< 0.001). Within EOCRC, Black patients (mean(SD), 7.17(7.55), p< 0.001) and Hispanic patients (6.68(8.98), p< 0.001) had longer LOS than White patients (5.78(6.38)).

Conclusion/Discussion: EOCRC hospitalizations disproportionately involve minority patients defined by longer hospital stays and higher rates of ostomy creation. These differences in care are multifactorial, but they highlight the need for equitable care for these high-risk patients. Further work that adjusts for covariates and uses data spanning multiple years is needed.