University of Iowa Hospitals and Clinics Iowa City, IA
Elizabeth Brindise, DO, MPH, Ye-Jin Lee, MD; University of Iowa Hospitals and Clinics, Iowa City, IA
Introduction: Colorectal cancer (CRC) is estimated to affect approximately 150,000 people in 2019.The rates of CRC have been declining since 1994 but despite the declining rate, mortality from this disease continues to be high. The aim of this study is to evaluate the temporal trends in prevalence and outcome of CRC in hospitalized patients based on race, insurance status and income quartile. Methods: The study population was obtained from the HCUP-NIS database for the years 2009-2015. ICD-9-CM codes were used to identify patients admitted with a primary diagnosis of CRC. Incidence of CRC and in hospital all-cause mortality were assessed based on race, insurance and income quartile. Results: There were 897,451 discharges with the primary diagnosis of CRC. Racial analysis revealed the prevalence of CRC in Whites, African Americans and Asian Americans remained statistically unchanged over the study time period. The Hispanic population saw a significant rise from 0.23 cases per 100 discharges in 2009 to 0.25 cases in 2015 (P = 0.024). In-hospital mortality decreased for all racial groups, except for the Asian cohort (2.54 deaths per 100 discharges in 2009 to 3.10 deaths in 2015, P=0.974).
High-income brackets (51st-75th and 76th-100th percentile) had the highest prevalence of CRC. Despite the high prevalence, the in-hospital mortality decreased significantly for both groups (3.66 deaths per 100 discharges in 2009 to 2.56 deaths in 2015 (P = 0.02) for the 51st-75th percentile cohort and from 3.57 deaths in 2009 to 2.38 deaths in 2015 (P=0.032) for the 76th-100th percentile). Mortality was not significantly changed in the 0-25th and 26th -50th percentile groups (3.83 deaths in 2009 to 3.42 in 2015, P=0.057 and 3.84 in 2009 to 2.79 in 2015, P=0.100, respectively). Insurance status analysis revealed a significant decrease in disease prevalence for insured patients over the study period. The in-hospital mortality for Medicare, Medicaid and private insurance also decreased significantly following the national trend. Discussion: Colorectal cancer prevalence in hospitalized patients in the US has remained stable between 2009 and 2015. During the same time, a significant decrease in in-hospital mortality is observed. Hispanics had a significantly rise in prevalence during the study period. Asian Americans were the only racial group with worsening in-hospital mortality. Unlike the national trend, low income individuals and the uninsured had unchanged mortality.
Disclosures: Elizabeth Brindise indicated no relevant financial relationships. Ye-Jin Lee indicated no relevant financial relationships.