Disparities in the prevalence of febrile neutropenia in patients hospitalized with lung cancer: An observational study.
Authors: Javaid Saad , Aziz Nouman , Frasier Kelly , Li Vivian , Ortega Yaguachi Nataly , Vinagolu-Baur Julia , Rodriguez Evadne , Del Castillo Olivia , Batista Raquel , Jonas Kenlee , Palma Laura 
Published: June 2024

e24133

Background: Lung cancer is a leading cause of cancer-related deaths in the United States and globally.Febrile neutropenia is a well-known and often fatal condition that occurs in 10-40% of lung cancer patients undergoing chemotherapy but has not been widely studied so far in these patients. We conducted a retrospective analysis to understand better the prevalence and disparities of febrile neutropenia in patients with lung cancer. Methods: The National Inpatient Sample (NIS) for the years 2017-2020 was utilized to identify patients with a primary discharge diagnosis of lung cancer which included both regional and metastatic disease. The cohort was stratified based on the presence or absence of Febrile Neutropenia (FN). Basic demographic variables were analyzed in order to identify disparities in the prevalence of FN among patients with lung cancer. Multivariate regression analysis was employed to determine the association between FN and lung cancer. Results: Among 461,975 hospitalized lung cancer patients, 4,355(0.09%) had concurrent diagnoses of febrile neutropenia (FN). Patients who developed FN were younger than those who did not (65.42±11.69 vs 68.81±10.39, p < 0.001). Older patients had a decreased likelihood of developing FN (36-45: OR = 0.36(0.16-0.79), p = 0.011; 46-64:OR = 0.26(0.13-0.51), p < 0.001 ; > 65: OR = 0.19(0.09-0.38), p < 0.001 ). The FN group had a greater proportion of black (17.81% vs 12.81%) and Hispanic (7.37% vs 5.25%, p < 0.001) populations, and these groups were more likely to develop FN than white patients (Black: OR = 1.39(1.14-1.69), p = 0.001; Hispanics: OR = 1.4(1.03-1.88), p = 0.027 ). Patients with a Charlson Comorbidity Index of 3 or higher had an increased likelihood of FN (OR = 1.39(1.09-1.76); p = 0.006). The FN group had a higher percentage of patients with Medicaid (15.46% vs. 9.81%) and private insurance (25.21% vs. 22.1%) and a lower percentage of patients with Medicare (56.96% vs. 65.9%), p < 0.001. A greater percentage of patients with FN were discharged to home with home health services (37.35% vs. 31.92%), while a greater percentage of patients without FN were discharged to home (65.31% vs. 59.91%) and skilled nursing facilities (2.06% vs. 1.98%), p = 0.032. Patients in medium and large hospitals were less likely to have FN compared to smaller hospitals (OR = 0.64(0.5-0.82), p = 0.001 and OR = 0.69(0.55-0.86), p = 0.001, respectively). Patients with fluid and electrolyte disorders were more likely to have FN (OR = 1.61(1.37-1.88), p < 0.001). Conclusions: Lung cancer patients who developed Febrile Neutropenia were younger and more likely to be Black and Hispanics. Patients hospitalized in the medium and large size hospitals were less likely to have Febrile Neutropenia in comparison to smaller hospitals. The statistics provide valuable insights for optimizing care and addressing disparities across different age and racial groups.