Clinical Outcomes and Healthcare Utilization in Mantle Cell Lymphoma: Using the National Inpatient Sample (NIS) 2021
Authors: Babu Kalaivani , Rajarajan Srinishant , Jayakumar Jayalekshmi , Ramesh Nithya , Ramanan Sruthi P , Chattaraj Asmi , Khan Eiraj , Dhamija Kriti , Correa Amit , Ayanambakkam Attanathi Adanma Anji , Roy Arya Mariam 
Published: December 2024

Background: Mantle cell lymphoma (MCL) is a rare type of non-Hodgkin lymphoma characterized by the overexpression of cyclin D1 due to a translocation between chromosomes 11 and 14. This study aims to investigate the epidemiology, clinical outcomes, and healthcare utilization of MCL patients using the National Inpatient Sample (NIS) - 2021 data.

Methods: Data from the NIS were analyzed to identify patients with MCL, defined by appropriate ICD-10 code. Descriptive statistics, adjusted odds ratios (OR), and regression analyses were employed to evaluate patient demographics, comorbidities, in-hospital mortality, length of stay (LOS), and total hospitalization charges. The primary outcome was in-hospital mortality, analyzed using logistic regression. Secondary outcomes included LOS and total hospitalization charges, analyzed using linear regression. Factors such as age, sex, race, socioeconomic status (ZIP code income quartile), Charlson Comorbidity Index (CCI), insurance status, hospital size, teaching status, admission day, and hospital region were considered.

Results: A total of 12,240 MCL cases were identified in the study. The majority were male (73.9%) and white (81.1%), with a mean age of 68.6 years (SE = 0.32). The Charlson Comorbidity Index (CCI) indicated significant comorbidity burden (63.3% with CCI ≥ 3). Socioeconomic status, as measured by median household income, showed that 28.8% of patients were in the highest quartile.

The primary outcome, in-hospital mortality, was 6.05% (95% CI: 5.10%-7.15%). The adjusted logistic regression analysis revealed that older age (OR: 1.03, 95% CI: 1.01-1.04, p=0.005) and higher CCI (OR: 1.13, 95% CI: 1.04-1.23, p=0.003) were significantly associated with increased mortality. Conversely, female gender was associated with lower mortality (OR: 0.50, 95% CI: 0.31-0.81, p=0.004). Racial categories, socioeconomic status by ZIP code income quartile, weekend admission, and hospital region were not significantly associated with in-hospital mortality.

The mean LOS was 7.52 days (95% CI: 7.06-7.99). Adjusted analyses showed that teaching hospitals had significantly longer stays (Coefficient: 2.18, 95% CI: 1.46-2.91, p&lt;0.001). Race had mixed results, with Hispanic patients having significantly longer stays (Coefficient: 1.78, 95% CI: 0.28-3.28, p=0.020) but other racial categories showing no significant differences. No significant differences in LOS were found for gender, ZIP code income quartile, weekend admission, or hospital region.

The mean total hospitalization charges were $134,115.50 (95% CI: $116,043.30-$152,187.70). Teaching hospitals had higher adjusted charges (Coefficient: $67,142.24, p&lt;0.001) and age was associated with lower total charges (Coefficient: -$2015.84, p=0.002). Race showed varied results, with Hispanic patients incurring significantly higher charges (Coefficient: $75,378.80, p=0.018) and Native American patients incurring significantly lower charges (Coefficient: -$44,524.19, p=0.037), but other racial categories showed no significant differences. Gender, ZIP code income quartile, and weekend admission were not significantly associated with hospitalisation charges.

Conclusion: This study highlights the significant clinical burden and healthcare utilization associated with MCL. Advanced age and comorbidity are key factors influencing in-hospital mortality. Female patients exhibit a survival advantage. The data also underscore the higher resource use in teaching hospitals. Several demographic and socioeconomic factors, such as race and ZIP code income quartile, did not significantly impact mortality, LOS, or hospitalization charges. These findings can inform clinical and policy decisions to optimize the care of MCL patients. Further research is warranted to explore interventions that could mitigate the observed disparities in outcomes and healthcare costs.