Racial Disparities in Hospitalization Outcomes Among Adult Patients with Neutropenia Using the National Inpatient Sample (2020)

Introduction:

Neutropenia is defined by a decreased number of neutrophils in the blood. It is categorized based on the absolute neutrophil count (ANC) into mild, moderate, severe, and agranulocytosis. The etiology of Neutropenia includes idiopathic and familial factors, as well as other conditions leading to decreased production or increased clearance of neutrophils. While Neutropenia can be a benign finding, it also has the potential to cause severe infections leading to hospitalizations. In this study, we aim to evaluate racial disparities that may exist among outcomes such as disposition, length of stay and total hospital charges of hospitalized neutropenic patients.

Methods:

We analyzed the National Inpatient Sample Database 2020 to identify hospitalizations > 18 years old with a primary diagnosis of Neutropenia using appropriate ICD 10 codes. The primary independent variable used in this study was race, which was stratified into White, African American, Hispanic, and other racial groups.

The primary outcomes assessed in this study were patient disposition, length of stay and total hospital charges. Patient discharge disposition was categorized into routine discharge (discharge to home or self-care), discharge to facility or home with home health care and death. The length of stay-in days was divided into less than 7 days and 7 or more than 7 days. Total hospital charge was analyzed as a continuous variable. Categorical variables were compared using the chi-square test, and the t-test compared continuous variables. Multivariable regression analyses were performed adjusting for demographics like age, gender, median household income quartiles and hospital-level characteristics such as hospital bed size, hospital region, and hospital location.

Results:

A total of 93,340 adult hospitalizations with a diagnosis of Neutropenia were identified. The mean age is 60 years and is slightly more prevalent in females (50.32%) than males (49.68%). Neutropenia hospitalizations are more common among Whites (63%) than African Americans (16%), Hispanics (11.2%) or other racial groups (9.8%).

Regardless of race, the majority of the patients are from the southern region of the USA with age < 70 years, who were admitted into small hospitals (fewer than 100 beds), with more than 50% of them undergoing a routine discharge and had a length of stay of less than 7 days.

In adjusted analyses, African American patients hospitalized for Neutropenia had higher odds (adjusted OR 1.20, 95% CI: 1.08-1.33) of being discharged to a facility or home with health care than their White counterparts. However, there is no statistical significance of in-hospital mortality when African Americans, Hispanics, and Other race categories were compared to Whites.

African Americans (adjusted OR 1.10, 95% CI: 1.002-1.22), Hispanics (adjusted OR 1.17, 95% CI: 1.03-1.31) and other racial groups (adjusted OR 1.21, 95% CI: 1.09-1.35) had higher odds of having a hospital stay of 7 or more days compared to their White counterparts.

Furthermore, Hispanics had a $23,444 higher (95% Cl: $8862 -$38,027) total hospital charge and other racial groups had a $32,936 higher (95% Cl: $17,639- $48,234) total charge compared to their White counterparts at discharge. There was no statistical significance in the total charge when African Americans were compared to Whites.

Conclusion:

In conclusion, we found significant differences in hospital outcomes among different racial groups of hospitalized neutropenic patients. We found no association between race and in‐hospital mortality versus routine discharge (home or self‐care). However, compared to Whites, African Americans had higher odds of getting discharged to a facility or home with health care. Furthermore, African Americans, Hispanics, and other racial groups had higher odds of having a hospital stay of 7 or more days when compared to their Whites. Additionally, Hispanics and other racial groups incur higher hospital costs compared to Whites. Racial minority populations may experience higher rates of comorbidities compared to the White population, significantly increasing healthcare costs. The results emphasize the necessity of enhancing the healthcare system in the United States, which involves shifting the focus toward prevention to improve health outcomes and lower healthcare expenses for minority populations.

No relevant conflicts of interest to declare.