Impact of race and ethnicity on financial toxicity in patients with genitourinary cancers.
Authors: Khosla Atulya Aman , Batra Nitya , Ganiyani Mohammad Arfat , Bellur Shreyas S , Ozair Ahmad , Jatwani Karan , Singh Rohit , Roy Mukesh , Rubens Muni , Saxena Anshul , Garje Rohan , Jaiyesimi Ishmael A. , Vaishampayan Ulka N. 
Published: June 2024

11077

Background: Genitourinary (GU) cancers contribute substantially to the cost of healthcare in the United States (US). While advancements in cancer treatment have improved patient outcomes, disparities in healthcare costs persist, exacerbating the financial burden on vulnerable populations. We sought to investigate the disparities in costs of inpatient hospitalizations among patients with GU cancers in the US. Methods: Eligible adult GU cases from the Medical Expenditure Panel Survey (2019–2021) were included in this study. ICD-10 CM codes were utilized to identify renal cell, prostate, urothelial, testicular, and penile cancers. In addition to the total hospital inpatient (IP) facility expenditure, questions about ability to pay for healthcare were included in the analysis after accounting for the complex survey design and sampling weights. Results: The study included a weighted sample size of 9,061,181 (wt SE = 538,502) GU cases in the US between 2019 and 2021. The mean (95% CI) age of the sample was 71.6 (70.7, 72.5) years. The sample consisted of 7.9% Hispanics, 74.8% non-Hispanic White (NHW), 13.8% non-Hispanic Black (NHB), and 3.5% Asian or other races (NHA). In 2021, NHB participants reported the lowest annual family income of $51742 (18932, 106185), followed by Hispanics with $65233 (24314, 95859), and NHW with 82035 (36298, 158863). A greater proportion of the elderly NHW population was insured compared to NHB and Hispanics (44.9% vs. 32.5% vs. 19.5%), respectively. Of note, NHB patients had worse self-perceived physical and mental health compared to NHW and Hispanics, with 18.1% reporting fair or poor physical and mental health (vs. 8.1% and 14.3%, respectively). NHB participants reported higher rates of familial financial hardship (2019: 10.2% vs. 3.6%; 2020: 6.2% vs. 3.5%; 2021: 7.1% vs. 3.3%) or not being able to afford medical care (2019: 7.2% vs. 2.1%; 2020: 2.5% vs. 0.6%; 2021: 1.9% vs. 1.7%) when compared to NHW. Overall, mean total hospital IP facility expenses were: Hispanics = $2873.30 (1434.49, 4312.12); NHW = $4213.81 (3241.05, 5186.56); and NHB = $5199.99 (2842.93, 7557.05). After accounting for sample weights, gender, family income, age, insurance status, and survey year, Poisson regression analysis showed significant differences between different racial groups. Hispanics were less likely (𝛽=-0.48; p<0.0001), while NHB (𝛽=0.152; p<0.0001) and NHA (𝛽=0.48; p<0.0001) were more likely to spend for an IP hospitalization when compared to NHW (ref.). Conclusions: Our data revealed racial disparities in the costs of inpatient hospitalizations, highlighting potential financial toxicity among patients with GU cancers. Additional investigation is warranted to elucidate factors contributing to these inequities, aiming to optimize cancer management and alleviate financial burdens. Addressing these disparities is crucial to prioritize equitable healthcare access and promote systemic change.