Racial Disparities in Inpatient Outcomes for Patients Admitted with Acute Myeloid Leukemia (AML)

Introduction

Racial disparities in healthcare manifest as differences in health outcomes, access to healthcare, and quality of care among different racial or ethnic groups. This study aims to investigate the characteristics and clinical outcomes of racial differences in patients admitted with acute myeloid leukemia (AML).

Methods

We analyzed data from the National Inpatient Sample from 2017 to 2020, focusing on adult patients of various races hospitalized with AML. The primary outcome was inpatient mortality; secondary outcomes included cardiac arrest, invasive mechanical ventilation, length of stay, and hospital costs. Multivariable logistic, linear, and Poisson regression analyses were employed to estimate clinical outcomes, with a p-value < 0.05 considered significant.

Result

The study included a total of 230,860 hospitalizations for AML, with a mean patient age of 62 years, and 54% of the patients were male. The racial distribution was as follows: Caucasian (162,585; 70.4%), Black (23,045; 9.9%), Asian (20,630; 8.9%), Hispanic (9,569; 4.1%), and others (15,130; 6.5%).

The non-insured subgroup was highest among Asians, followed by Hispanics, while Medicaid coverage was highest among Asians, followed by Blacks. Anemia was highest among Hispanics, followed by Blacks and Asians. Neutropenia was also highest among Hispanics, followed by Asians. Thrombocytopenia rates were similar among the subgroups. Protein-calorie malnutrition was most prevalent among Hispanics, followed by Blacks. Chronic kidney disease (CKD) was highest among Blacks, followed by Caucasians. Tobacco and alcohol abuse were most prevalent among Blacks, followed by Caucasians. Diabetes rates were highest among Asians, followed by Blacks and Hispanics. Hypertension was most common in Blacks, followed by Caucasians and Hispanics. Obesity rates were highest among Blacks, then Asians and Caucasians.

Cardiac arrest rates were Caucasian (1,659; 1%), Blacks (404; 1.7%), Asian (195; 0.9%), Hispanics (115; 1.2%). When Caucasian is taken as baseline, the odds ratio (OR) for Cardiac arrest are Blacks 1.9 (CI 1.4-2.6, p 0.00), Asian 1.1 (CI 0.7-1.7, p 0.5), Hispanics 1.7 (1.1-2.7, p 0.03).

Intubation rates were Caucasian (6,984; 4.3%), Blacks (1,235; 5.4%), Asian (1,010; 4.9%), and Hispanics (475; 5%). When Caucasians were taken as the baseline, the OR for intubation were Blacks 1.3 (CI 1.1-1.5, p 0.004), Asians 1.4 (CI 1.1-1.7, p 0.001), Hispanics 1.6 ( CI 1.2-2, p 0.0).

Length of stay was not statistically significant across racial groups. Hospital costs were highest among Hispanics followed by Asians, Blacks. When Caucasians as baseline, the incidence rate ratio (IRR) for hospital costs were Blacks 0.97 (CI 0.9-1.03, p 0.4), Asians 1.17 (CI 1.1-1.3, p 0.002), Hispanics 1.4 (CI 1.2-1.5, p 0.0).

All-cause mortality was reported in 19,944 cases. Mortality rates by subgroup were Caucasian (14,124; 8.7%), Black (1,975; 8.6%), Asian (1,435; 6.9%), Hispanic (845; 8.9%). When Caucasians as baseline, the OR for mortality were Blacks 1.07 (CI 0.9-1.2, p 0.3), Asians 1.07 (CI 0.9-1.2, p 0.3), Hispanics 1.3 ( CI 1.1-1.5, p 0.008).

Conclusion

This study reveals significant racial disparities in the clinical outcomes of patients hospitalized with AML. Blacks and Hispanics had higher rates of cardiac arrest and invasive mechanical ventilation compared to Caucasians. Hospital costs were notably higher for Hispanics and Asians. Despite these differences, inpatient mortality rates were relatively similar across most racial groups, with Asians showing a slightly lower mortality rate compared to Caucasians, Blacks, and Hispanics.

These findings signifies the need for targeted interventions to address the underlying causes of these disparities. Efforts should focus on improving access to healthcare, ensuring culturally competent care, and addressing social determinants of health that disproportionately affect minority populations. The higher prevalence of protein-calorie malnutrition among Hispanics and Blacks, and the higher rates of chronic kidney disease and substance abuse among Blacks, indicate specific areas for health interventions. Addressing these factors is essential for creating a more equitable healthcare system where all patients receive the highest standard of care, regardless of their racial or ethnic background.