Abstract PS4-09-07: Insurance Status as a significant contributor of disparities in outcomes among young breast cancer patients- A retrospective analysis from National Inpatient Sample

Abstract Background: Young women with breast cancer often experience more aggressive disease and worse outcomes. Beyond biological factors, we aimed to evaluate whether insurance status also contributes to disparities in clinical outcomes. This study compares clinical characteristics and outcomes of young breast cancer patients with private insurance versus Medicaid. Methods: We conducted a retrospective cohort analysis using National Inpatient Sample 2016-2020. Young female patients (age 18 - 50) with breast cancer were stratified by insurance status: Private insurance and Medicaid. Baseline characteristics, comorbidities, hospital features, and primary and secondary outcomes were compared. Multivariate logistic regression was used to derive adjusted odds ratios (aOR), while adjusting for age, race, Charlson Comorbidity Index, hospital region, teaching status of hospital, hospital bedsize, urban versus rural location, and ZIP code-based income quartiles. Results: A total of 144,080 young breast cancer patients were included in the study, of whom 81,025 (66.4%) had private insurance and 40,930 (33.6%) were insured through Medicaid.Patients with Medicaid were younger (mean age 41 vs 42.17 years, P<0.001), more likely to be African American (30.1% vs 16.1%) or Hispanic (22.9% vs 11.3%), and from lower-income ZIP codes (P<0.001). They had higher rates of comorbidities including anemia (37.2% vs 30.6%), diabetes (11.6% vs 6.8%), and smoking (31.7% vs 20.2%) (P<0.001 for all) Despite these disparities, there was no significant difference in in-hospital mortality between Medicaid and privately insured patients (4.33% [n = 1,770] vs 3.31% [n = 2,680]; aOR 1.004, P = 0.955). However, Medicaid patients had longer hospital stays (4.92 vs 3.74 days; aOR 1.21, P<0.001) and lower total hospitalization charges ($64,150 vs $71,780; aOR 0.87, P<0.001). Medicaid coverage was independently associated with higher risks of sepsis (aOR 1.15, P=0.041), acute kidney injury (AKI) (aOR 1.26, P<0.001), acute respiratory failure (ARF) (aOR 1.17, P=0.026) and pulmonary embolism (aOR 1.33, P=0.024) (Table 1). Conclusions: Although in-hospital mortality was similar between Medicaid and privately insured young breast cancer patients, those with Medicaid experienced significantly more complications, longer hospital stays, and came from more socioeconomically disadvantaged backgrounds. The paradox of lower hospitalization charges despite longer hospital stay and increased complications may reflect systemic inequities in care delivery and resource allocation. These findings underscore the need for targeted interventions and equitable access to mitigate disparities. Citation Format: V. Deenadayalan, V. Muthusamy Kumarasamy, L. Calvin Yee Fen, S. Gandhi. Insurance Status as a significant contributor of disparities in outcomes among young breast cancer patients- A retrospective analysis from National Inpatient Sample [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-07.