Abstract A124: Neighborhood, race and insurance predict for hospital admission during radiation therapy
Authors: Wakefield Daniel V , Carnell Matthew , Jiang Bo , Dove Austin , Garner Wesley , Edmonston Drucilla , Hubler Adam , Ozdenerol Esra , Hanson Ryan , Pisu Maria , Schwartz David L , Schwarts David L 
Published: September 2020

Abstract
Background: Hospital admission during radiotherapy (ADRT) is associated with increased cost, interrupted treatment, and inferior outcomes. The purpose of this study was to benchmark patient ADRT rates, define socioeconomic predictors for ADRT, and geographically map ADRT rates on the neighborhood level across a large Mid-Southern catchment region served by a single academic cancer referral center. Methods: Demographic, clinical and treatment information were collected for all patients treated with radiation therapy (RT) at our center from January 1, 2015 to December 31, 2017. Occurrence of ADRT included inpatient and emergency room admissions. ADRT was categorized as causing “minor interruption” if ADRT was associated with postponement in 1-4 RT treatments. “Major interruption” was defined as postponement in 5 or more treatments. Patients with Medicaid or no insurance were categorized as “At-Risk”. Patient predicted income (PPI) was modeled using 2017 US Census data for annual household income by patient residence census tract, categorized into low (&lt;$34k), middle, and high (&gt;$67k) thirds. ADRT rates were compared across variables, analyzed using Pearson’s Chi square testing, and geomapped by patient residence at the neighborhood (census tract) level. Results: 3,729 patients were included. 2,032 (54.5%) were Caucasian, 1,577 African American (42.3%), and 120 (3.2%) other. Insurance status was defined as Commercial, Medicare, or At Risk in 1,794 (48.1%), 1,503 (40.3%), and 432 (11.6%) patients. The mean PPI was $49,951 (range $10,871-$177,857). A total of 83,306 fractions (median 24, IQR 11-30) were delivered with 7,107 (8.5%) total interruptions. 727 interruptions (mean 0.19, range 0-21) were due to ADRT in 197 patients (5.3%). Minor interruption rates were significantly elevated in At Risk patients v. those with Commercial or Medicare insurance (7.4% v 3.5% p=&lt;0.0001; OR 2.21 [95%CI 1.47-3.31]), African American v. Caucasian patients (5.1% v 3.1% p=0.002; OR 1.66 [95%CI 1.19-2.32]), and low PPI v. high PPI patients (5.2% v 2.5% p=&lt;0.0005; OR 2.17 [95%CI 1.39-3.39]). Major interruption rates were similar across all groups: At Risk v. Commercial or Medicare insurance (1.6% v 1.2% p=0.591; OR 1.25 [95%CI 0.55-2.79]), African American v. Caucasian ([1.3% v 1.4% p=0.74; OR 0.91 [95%CI 0.51-1.61]), and low PPI v. high PPI (1.4% v 1.3% p=0.93; OR 1.03 [95%CI 0.52-2.05]). Elevated minor interruption rates were geographically associated with low income, predominately African American neighborhoods across our treatment region. Conclusion: At our high-volume academic radiotherapy practice, hospital admission during RT correlated significantly with uninsured or Medicaid coverage status, African American race, and low predicted income and mapped to low income neighborhoods, suggesting limited care access for these populations. Major hotspot locations have been identified, setting the stage for targeted studies to close gaps in RT quality.
Citation Format: Daniel V Wakefield, Matthew Carnell, Bo Jiang, Austin Dove, Wesley Garner, Drucilla Edmonston, Adam Hubler, Esra Ozdenerol, Ryan Hanson, Maria Pisu, David L Schwartz, David L Schwarts. Neighborhood, race and insurance predict for hospital admission during radiation therapy [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A124.