Risk factors for mortality and financial burdens in patients with colon cancer.
Authors: Zahid Zaid , Zengin Bugra , Alqaisieh Mohammad , Duhaime Lisa A. 
Published: January 2025

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Background:
Colon cancer remains one of the most common cancers of the digestive system and continues to rank high among the leading causes of cancer-related deaths, despite the increased prevalence of screening. In this study, we aimed to investigate risk factors for mortality and health care costs in hospitalized patients diagnosed with colon cancer.
Methods:
Patients admitted to the hospital in 2019 and 2020 were identified using the Nationwide Inpatient Sample database and categorized into two groups based on the presence of colon cancer (with relevant ICD-10 codes). To account for confounding factors, multivariate regression analysis was applied to calculate mortality. Statistical analyses were conducted to assess mortality rates, length of stay, and hospital charges.
Results:
A total of 169,805 patients were admitted with a primary diagnosis of colon cancer, with a mean age of 67.6 years. The majority were White (69.9%), and 50.2% were male. Age over 60 (OR: 1.67, p < 0.001) and sepsis (OR: 16.01, p < 0.001) were associated with increased in-hospital mortality among colon cancer patients, while higher household income (76th to 100th percentile, OR: 0.71, p = 0.011) and treatment at an urban teaching facility (OR: 0.54, p < 0.001) were linked to a lower risk of in-hospital mortality. Female gender (OR: 0.88, p = 0.080) and having inflammatory bowel disease (OR: 0.67, p = 0.055) did not significantly affect in-hospital mortality, nor did Black race (OR: 1.1, p = 0.348) or Hispanic race (OR: 1.15, p = 0.287) compared to White patients. Sepsis (+11.8 days, p<0.001; +$192,699, p< 0.001), age over 60 (+0.99 days, p<0.001; +$6,134, p<0.001), and care at urban teaching hospitals (+0.54 days, p< 0.001; +$32,230, p< 0.001) were associated with longer hospital stays and higher total charges. Conversely, female gender (-0.21 days, p=0.001; -$5,529, p<0.001) and higher income (-0.69 days, p<0.001; -$1,565, p=0.466) were linked to shorter hospital stays and lower total charges.
Conclusions:
Early recognition of sepsis in colon cancer patients could potentially reduce in-hospital mortality rates, as well as significantly decrease costs and length of stay. The higher mortality rates observed in patients with sepsis may be attributed to the immunocompromised state associated with cancer. Implementing targeted interventions to address the higher risks in older patients and those with sepsis could improve outcomes and reduce the overall burden of colon cancer-related hospitalizations.

Impact of patient demographics, socioeconomic factors, and clinical conditions on mortality, length of hospital stay, and total hospital charges.

Data
Mortality
Length of Hospital stay
Total Charge

Age>60
1.67 (p< 0.001)
0.99 days, p<0.001
$6428, p< 0.001

Race (Hispanic compared to White race)
1.15 (p=0.287)
0.38 days, p= 0.004
$14,127, p<0.001

Race (Black compared to White race)
1.1 (p=0.348)
1.4 days, p< 0.001
$5370, p=0.002

Female gender
0.88 (p=0.08)
-0.21 days, p= 0.001
-$5529, p< 0.001

High house hold income
0.71 (p= 0.011)
-0.69 days, p<0.001
-$1565, p= 0.466

Treatment at urban teaching facility
0.54 (p<0.001
0.54 days, p<0.001
$32230, p< 0.001

Sepsis
16.01 (p<0.001)
11.8 days, p<0.001
$192699, p< 0.001

IBD
1.05 (p=0.888)
0.67 days, p=0.055
$5348, p=0.293