Hospital designation and survival disparities in young-onset gastrointestinal cancer.

1535 Background: Early-onset gastrointestinal (GI) cancers (<50 years) are increasing in incidence. We examined the impact of National Cancer Institute (NCI) designation and academic affiliation on mortality and care delivery for young-onset GI cancer patients in New York State. Methods: We performed a retrospective analysis using the Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2024. Patients were stratified by admission type (emergency vs elective) and hospital site (NCI vs non-NCI; academic vs community). GI cancers included anal, biliary, colorectal, esophageal, gallbladder, liver, pancreatic, peritoneal, small intestine, and gastric cancers. Clinical characteristics were defined using the All Patient Refined grading system. Academic hospitals were classified via the Association of American Medical Colleges Database. Wilcoxon rank-sum tests compared continuous variables; Chi-squared or Fisher's exact tests for categorical variables. Linear regression was performed for continuous outcomes, and multinomial logistic regression for categorical outcomes, with significance at P ≤ 0.05. Results: A total of 29,753 young-onset GI cancer patients were included, of which 48.7% were emergency admissions. For emergency admissions, NCI sites treated patients with higher illness severity, and most had private insurance (P<0.001). There was no significant difference in length of stay (LOS) between NCI and non-NCI sites. Cost of treatment was significantly higher at NCI sites (P<0.001), which also performed more procedures (P = 0.002). NCI sites were associated with 36% lower odds of in-hospital mortality (OR=0.64 [0.55-0.75], P<0.001) despite higher illness severity. For elective admissions, in-hospital mortality was 0.5% at NCI sites vs 7.3% at non-NCI sites (OR=0.04 [0.03-0.05], P<0.001). For emergency admissions, academic sites treated patients with higher illness severity, and most patients had private insurance (P<0.001). Admission to an academic site was associated with increased LOS (β=0.03 [0.02-0.05], P<0.001). Cost of treatment was significantly higher at academic sites (P < 0.001), which performed more procedures (P <0.001). No significant difference in mortality was seen between academic and community sites. For elective admissions, in-hospital mortality was 0.5% at academic sites vs 5.8% at community sites (OR=0.08 [0.06-0.11], P<0.001). Across all hospitals and admission types, private insurance was independently associated with shorter length of stay (P<0.001). Conclusions: Treatment at NCI-designated centers for both emergent and elective admissions was associated with significantly lower in-hospital mortality among young-onset GI cancer patients despite higher illness severity. Insurance-based disparities highlight the need for interventions to ensure equitable access to high-quality cancer care for this vulnerable population.