Utilization, costs, and mortality in hospitalized incarcerated patients with cancer in the US: A national cohort study.

104 Background: Cancer is the leading cause of death among incarcerated adults in the US. Adults currently or formerly incarcerated face high cancer mortality. Hospitalization outcomes (including interventions, mortality, and costs) remain unstudied in this population. Methods: All hospitalized adults aged ≥18 with a principal cancer diagnosis were identified in the 2016 - 2022 National Inpatient Sample. Incarcerated and non-incarcerated patients were matched by age, sex, race and ethnicity, insurance type, cancer diagnosis, number of comorbidities, substance use disorder, severity of illness, year of admission, and hospital location, ownership, region, and bed size using propensity score matching. Matched pairs were identified using a 1:1 nearest neighbor matching algorithm without replacement, accounting for survey weights. Logistic regression tested associations of carceral status and: receipt of systemic therapy (chemo/immunotherapy) or radiation, cost of care, and mortality. Adjusted analysis accounted for sociodemographics, comorbidities, and substance use history. Results: Overall, 1,633 incarcerated and 3,836,117 non-incarcerated adults with cancer were included. In the unmatched cohort, there were differences in age (i.e. 45-64 years old (52% incarcerated vs 41% non-incarcerated)), male sex (93% vs 53%), race (Black, 29% vs 13%; Hispanic, 14% vs 9%; White, 50% vs 69%), and insurance (Medicaid, 27% vs 11%; no/unknown, 52% vs 3%). The incarcerated had a higher proportion of patients with a length of stay >5 days (43% vs 31%) and with substance use (22% vs 16%). There were also differences by primary cancer, with higher rates of upper/lower GI cancers (29% vs 20%). (p<0.001 for all). In the matched cohort, on adjusted analyses there were no differences in receipt of systemic therapy (12% incarcerated vs 11% non-incarcerated, p=0.13) or radiation therapy (1% vs 1%, p=0.1). Carceral status was not associated with higher-than-median cost of stay (61% vs 58%, p=0.1) and or death during admission (5% vs 6%, p=0.1). Conclusions: This first nationwide analysis of hospitalization outcomes in incarcerated adults with cancer finds no differences in cost, intervention, or hospital death. This may reflect the benefits of facilitated care or a carefully selected carceral population who makes it to the hospital. As incarcerated patients are a high-risk group, further research is essential to understand gaps in care driving known outcomes disparities. Inpatient care delivery and outcomes among incarcerated in matched cohort. Characteristic Incarcerated Non-Incarcerated p-value N = 8,165 1 N = 7,605 1 Receipt of Chemo/Immunotherapy 1,015.0 (12.4%) 796.4 (10.5%) 0.13 Receipt of Radiation 105.0 (1.3%) 107.1 (1.4%) 0.7 Death During Admission 400.0 (5.0%) 484.3 (6.4%) 0.1 High Cost of Stay 4,975.0 (60.9%) 4,405.6 (57.9%) 0.11 1 After accounting for survey weights.