There Is No Difference in the Prevalence of Neutropenia or Fever in Hospitalized African-Americans and Caucasians with Cancer in the SEER-Medicare Database.
Authors: Hsieh Matthew M. , Duan Zhigang , Wright Elizabeth C. , Tisdale John F. , Rodgers Griffin P 
Published: October 2019

Abstract 2499

Poster Board II-476

Individuals of African descent have been shown to have relative reduction in neutrophil counts compared to individuals of other ethnicities. Benign ethnic neutropenia (BEN) is a condition described more commonly in individuals of African descent where their neutrophil counts are between 1000-1500 cells/uL. BEN prevalence decreases with age: about 10% in children and adolescents, and 5% in adults of the US population. The lower neutrophil counts has been proposed to be one barrier of African-American (Af-Am) cancer patients to receive high quality chemotherapy. We therefore sought to determine whether lower neutrophil counts affect the outcomes of chemotherapy in Af-Am with respect to the prevalence of neutropenia and hospitalization rate for neutropenia. We analyzed SEER-medicare database for all individuals diagnosed with cancer of the breast, lung, prostate, colon/rectum, and lymphoma between 2002-2006, extracted those who received chemotherapy, and were hospitalized in the next 6 months for neutropenia (ICD-9 code 288.0) or fever (780.6). There were 192,089 Af-Am and Caucasian cancer patients from the database; only 8.22% were Af-Am. 39.24% of Af-Am and 36.15% of Caucasians cancer patients received chemotherapy. Among all patients who received chemotherapy, Af-Am were younger in age at diagnosis, have more distant disease, and fewer had surgeries or radiation. Since there is no diagnostic code for neutropenic fever, we analyzed hospitalized patients with codes for neutropenia or fever. Among Af-Am patients whom received chemotherapy (n=6,199), 132 (2.13%) were hospitalized with neutropenia as one of the diagnoses; among Caucasians whom received chemotherapy (n=63,729), 1897 (2.98%) were hospitalized with neutropenia. When the duration of hospitalization was analyzed, more Af-Am with breast cancer were hospitalized for longer than 2 weeks. Af-Am with other cancers did not have longer hospitalizations. 40 Af-Am patients (0.65%) were hospitalized with fever, compared to 478 Caucasian patients (0.75%). There were insufficient numbers of patients with neutropenia and fever to analyze. In conclusion, Af-Am comprised a small percentage of cancer patients in the SEER-Medicare database. Compared to Caucasians, slightly more Af-Am patients with breast cancer received chemotherapy, and some of them had longer hospitalization. There is no statistical difference between the prevalence of neutropenia or fever among hospitalized Af-Am or Caucasian cancer patients.

Breast Lung Prostate Colorectal lymphoma % Af-Am Cauc Af-Am Cauc Af-Am Cauc Af-Am Cauc Af-Am Cauc chemo 27.3* 21.3 40.3 38.3 47.7 48.0 31.2 32.3 46.0* 54.7 Hosp + neutropenia 6.0 5.8 6.2 12.5 0.08 0.08 3.9 4.5 12.5 15.8 Number of hosp** No diff No diff No diff No diff No diff Longer hosp duration** Yes* No No No no * p<0.05 ** compared to Caucasians

Disclosures:

No relevant conflicts of interest to declare.