Decreasing mortality and hospitalizations with rising costs related to gastric cancer in the USA: an epidemiological perspective

Abstract

BackgroundThere is no convincing data on the trends of hospitalizations, mortality, cost, and demographic variations associated with inpatient admissions for gastric cancer in the USA. The aim of this study was to use a national database of US hospitals to evaluate the trends associated with gastric cancer.MethodsWe analyzed the National Inpatient Sample (NIS) database for all patients in whom gastric cancer (ICD-9 code: 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9) was the principal discharge diagnosis during the period, 2003–2014. The NIS is the largest publicly available all-payer inpatient care database in the US. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by regression analysis.ResultsIn 2003, there were 23,921 admissions with a principal discharge diagnosis of gastric cancer as compared to 21,540 in 2014 (P < 0.01). The mean length of stay for gastric cancer decreased by 17% between 2003 and 2014 from 10.9 days to 8.95 days (P < 0.01). However, during this period, the mean hospital charges increased significantly by 21% from $ 75,341 per patient in 2003 to $ 91,385 per patient in 2014 (P < 0.001). There was a more significant reduction in mortality over a period of 11 years from 2428 (10.15%) in 2003 to 1345 (6.24%) in 2014 (P < 0.01). The aggregate charges (i.e., “national bill”) for gastric cancer increased significantly from 1.79 bn $ to 1. 96 bn $ (P < 0.001), despite decrease in hospitalization (inflation adjusted).ConclusionAlthough the number of inpatient admissions for gastric cancer have decreased over the past decade, the healthcare burden and cost related to it has increased significantly. Inpatient mortality is decreasing which is consistent with overall decrease in gastric cancer-related deaths. Cost increase associated with gastric cancer contributed significantly to the national healthcare bill.

Inpatient burden of gastric cancer in the United States

“…To our knowledge, this is the second retrospective study determining the inpatient burden of gastric cancer in the U.S. Liu et al conducted a similar study using NIS database in 2018 (20). All other studies have reported findings from population-based cancer registries like Surveillance, Epidemiology, and End Results (SEER), United States (24,25).…”

Progress and challenges in HER2-positive gastroesophageal adenocarcinoma

“…In the USA, gastric cancer represents 1.5% of all new cancers with estimated new cases to be 26,240 and estimated deaths to be 10,800 in 2018 [2]. Despite the trend of decreasing incidence and mortality, the cost and healthcare burden related to gastric cancer increased significantly [3, 4]. Gastric cancer is often diagnosed at an advanced stage, defined as unresectable locoregional or metastatic disease, which has very poor prognosis with 5-year survival not exceeding 5–20%.…”

Incidence and death in 29 cancer groups in 2017 and trend analysis from 1990 to 2017 from the Global Burden of Disease Study

“…Also the declination of the incidence rates of stomach cancer is correlated with the overall declination and improved management of Helicobacter pylori infection [34]. But the healthcare costs and burden of stomach cancer has increased, requiring much attention by the government [35]. Moreover, it should be noted that the ASDR of liver cancer in 2017 was increased by 75% when compared with 1990 in North America, and the ASDR of TBL cancer [34.09(34.99-33.25)] accounted for more than 25% of all cancers in 2017.…”