Cholangiocarcinoma care across America: A tale of two coasts.

e16241 Background: Cholangiocarcinoma (CCA) is an aggressive biliary cancer with a historically poor prognosis and a recent rise in global incidence. Clinical trends suggest geographic location as a major social determinant, with literature indicating disproportionate disease burden in the Northeast (NE) and West (W) regions of the United States. Identifying the underlying causes of this disparity is essential to achieve health equity. This study utilizes the National Inpatient Sample (NIS) database to analyze the characteristics, clinical outcomes, and healthcare costs of CCA hospitalizations in the NE and W regions of the United States. Methods: A retrospective cohort study was conducted using the 2019–2023 NIS database. Adult patients (≥18 years) hospitalized with CCA were identified using ICD-10 codes and divided into Northeastern (NE) and West (W) regions. NE was taken as reference. Baseline characteristics and outcomes were compared among NE and W using univariate and multivariate logistic regression analysis. Results: Among 189,820 CCA hospitalized patients, 16.7% (n = 31,699) occurred in the NE and 16.8% (n = 31,889) in the W. Patients' ages were slightly similar in both regions (68 vs 69 years; coefficient: -0.50; P = 0.077), Male were the predominant gender (NE 16,800; 53% and W 17,220; 54%). Racial distribution varied significantly, White predominantly in both groups (NE 22,189; 70% and W 16,582; 52%), followed by hispanic race (NE 3,170; 10% W 7,653; 24%). Clinical outcomes were more favorable in the W, with the NE demonstrating higher in-hospital mortality (8% vs 7%; OR: 0.84; P < 0.05) and longer length of stay (LOS) (7.3 vs 6.6 days; Coefficient: 0.70; P < 0.001). However, W exhibits higher hospital charger costs ($102,559 vs $120,933; Coefficient: $18,374; P < 0.001). Most cases were managed at large hospitals (NE: 58%; W: 65%) and teaching institutions (NE: 91%; W: 82%; p < 0.001). Medicare was the primary payer (NE: 61%; W: 60%), followed by private insurance (NE: 27%; W: 24%). Conclusions: Significant regional disparities exist in CCA outcomes, with higher prevalence, mortality and longer LOS in the NE, but higher healthcare costs in the W. Though this corroborates recent trends indicating geographical disparity in CCA, the reasons remain unclear. Differential hospital courses, resource utilization, cost inflation and socioeconomic variables uniquely impact regional care. Further research is needed to identify the specific drivers and optimize equitable, cost-effective management.