Abstract C097: Racial and socioeconomic disparities in surgical treatment and outcomes for lung cancer before, during, and after the COVID-19 pandemic: A national inpatient sample study (2016–2022)

Abstract Background Surgical resection is the standard curative treatment for early-stage non–small cell lung cancer (NSCLC), yet access remains inequitable. The COVID-19 pandemic strained hospital capacity and may have worsened disparities in lung cancer care. How race, income, and hospital factors shaped surgical treatment and outcomes across the pandemic period remains unclear. Methods We analyzed the National Inpatient Sample (2016–2022), identifying lung cancer hospitalizations via ICD-10-CM code C34.x. Surgical procedures were categorized as lobectomy, wedge resection, or other, using ICD-10-PCS codes. We defined three periods: pre-COVID (2016–2019), COVID (2020–2021), and post-COVID (2022). Multivariable, survey-weighted logistic and linear regression models assessed associations between patient demographics (race/ethnicity, sex, age, income quartile, primary payer, Charlson Comorbidity Index), hospital characteristics (region, teaching status, urban/rural), and key outcomes: surgery receipt, surgery type (lobectomy vs wedge), in-hospital mortality, length of stay (LOS), and total hospital charges. We evaluated 3-way interactions (race × surgery type × COVID period) to assess disparities over time. Results Among 48.2 million hospitalizations, 36,012 patients underwent lung cancer surgery (weighted N ≈ 241,000). Black and Hispanic patients were significantly less likely to receive lobectomy over wedge resection than White patients (aOR for Black = 0.78, p=0.014). Female sex, advanced age, and higher Charlson scores were associated with lower lobectomy odds (p<0.001). Wedge resection was linked to lower in-hospital mortality (1.3%) than lobectomy (9.7%, p<0.001). During COVID, Black patients undergoing lobectomy had higher mortality and longer LOS than White patients (p<0.01). Surgery rates declined during the pandemic (aOR 0.73, 95% CI: 0.68–0.78), disproportionately among low-income and minority groups (interaction p<0.01). Lobectomy incurred nearly double the hospital cost vs wedge ($236,435 vs $125,649, p<0.001). Conclusion Racial and socioeconomic disparities in lung cancer surgery persist and worsened during COVID-19. Black, Hispanic, and low-income patients were less likely to undergo lobectomy and had worse outcomes. The surgical approach was shaped by social determinants impacting mortality and cost. Addressing these inequities is critical to restoring justice and quality in cancer care delivery. Citation Format: Nehemias Guevara Rodriguez, Brian Abboud, Wint Aung, Abner A. Murray, Noemy Coreas, Fatima Kamal, Dawson Foster, Asha Ricciuti. Racial and socioeconomic disparities in surgical treatment and outcomes for lung cancer before, during, and after the COVID-19 pandemic: A national inpatient sample study (2016–2022) [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C097.