Breaking Barriers: Hospitalization Trends and Outcomes of Tumor Lysis Syndrome in the Transgender Population (2016-2022) Using NIS Database
Authors: Basharat Ahmad , Rehman Ateeq , Mumtaz Aqsa , Naeem Ammad , Khan Marjan , Khan Atif N , Aslam Afifa , Nawaz Gul , Shahzad Moazzam 
Published: December 2024

Background
Transgenders are individuals with a gender identity that differs from their sex at birth. Over 1.6 million adults identify themselves as transgender in the US, with 39% identifying as women and 36% as men. While gender differences in cancer prevalence have been well established between men and women, very few studies evaluate the prevalence of cancer in transgender individuals. This study aimed to evaluate the trends of Tumor Lysis Syndrome (TLS) hospitalization in the transgender population compared to the general population.
Methods
This was a retrospective analysis of the data obtained from the Nationwide Inpatient Sample (NIS) database. Data were sampled from 2016 to 2022 using the ICD-10 codes for TLS in patients (&gt;18 years) who identified as transgender. The primary outcome was in-hospital mortality. Secondary outcomes included the length of stay (LOS) and total hospital costs. A multivariate logistic regression analysis was used to estimate the odds ratio (OR) for in-hospital mortality.
Results
A total of 78,567 patients with TLS were admitted between 2016 and 2022, of which 12,564 were transgender. The mean age was 38 years for transgender patients and 42 years for the general population. Both groups were predominantly Caucasian, with 60% of transgender patients and 63% of the general population identifying as Caucasian, followed by 18% of transgender patients and 12% of the general population identifying as African American. The median household income (MHI) distribution showed that 30% of transgender patients were in the lower quartile, compared to 20% of cisgender patients. In the 26th-50th percentile, 25% of transgender patients and 35% of cisgender patients were represented. For the 51st-75th percentile, 20% of transgender patients fell into this category, compared to 17% of cisgender patients. Finally, in the 76th-100th percentile, 25% of transgender patients were represented, compared to 28% of cisgender patients.
Hospital size and region also varied. Transgender patients were more frequently admitted to larger hospitals (65%) compared to cisgender patients (55%), while smaller hospitals saw 20% of transgender patients and 30% of cisgender patients. The regional distribution indicated that 40% of transgender patients were admitted in the West, 25% in the Northeast, 20% in the South, and 15% in the Midwest. For cisgender patients, the distribution was 30% in the West, 20% in the Northeast, 30% in the South, and 20% in the Midwest.
In-hospital mortality for transgender patients with TLS was significantly higher, with an odds ratio (OR) of 3.7 [2.2-6.4] (p &lt; 0.05). The average length of stay (LOS) was higher in the transgender population by 2.6 days [1.3-3.9] (p &lt; 0.05). Increased LOS was observed in teaching hospitals by 1.5 days [1.1-2.0] (p &lt; 0.001) and in larger hospitals by 1.7 days [0.9-2.5] (p &lt; 0.001). The total cost of admission was significantly higher in teaching hospitals for transgender patients, with costs amounting to $31,850 compared to $27,774 for cisgender patients (p &lt; 0.001).
Conclusion
We found a significant difference between the inpatient outcomes of transgender and the general population. Despite the markedly low representation of transgender people in national cancer registries, they experienced increased mean length of stay and mortality compared to cisgender patients with TLS. Further investigation is required to determine the cause of disparities in healthcare utilization among the gender-diverse population. These findings highlight the need for inclusive healthcare practices and policies to address the unique needs of transgender patients, ensuring equitable treatment and outcomes.