Racial disparities in inpatient clinical presentation, treatment, and outcomes in brain metastasis

Abstract

Background Few studies have assessed the impact of race on short-term patient outcomes in the brain metastasis population. The goal of this study is to evaluate the association of race with inpatient clinical presentation, treatment, in-hospital complications, and in-hospital mortality rates for patients with brain metastases (BM). Method Using data collected from the National Inpatient Sample (NIS) between 2004 and 2014, we retrospectively identified adult patients with a primary diagnosis of BM. Outcomes included non-routine discharge, prolonged length of stay (pLOS), in-hospital complications, and mortality. Results Minority (Black, Hispanic/other) patients were less likely to receive surgical intervention compared to White patients (OR 0.70; 95% CI 0.66 – 0.74, p < 0.001; OR 0.88; 95% CI 0.84 – 0.93, p < 0.001). Black patients were more likely to develop an in-hospital complication than White patients (OR 1.35, 95% CI 1.28-1.41, p < 0.001). Additionally, minority patients were more likely to experience pLOS than White patients (OR 1.48; 95% CI 1.41 – 1.57, p < 0.001; OR 1.34; 95% CI 1.27 – 1.42, p < 0.001). Black patients were more likely to experience a non-routine discharge (OR 1.25; 95% CI 1.19 – 1.31, p < 0.001). Black patients were more likely to experience higher in-hospital mortality than white (OR 1.13; 95% CI 1.03-1.23, p = 0.008). Conclusion Our analysis demonstrated that race is associated with disparate short-term outcomes in patients with BM. More efforts are needed to address these disparities, provide equitable care, and allow for similar outcome regardless of care.

Disparities in Kidney Transplant Waitlisting Among Young Patients Without Medical Comorbidities

“…For example, prior investigations have shown that factors such as a history of substance use are more likely to cause Black kidney transplant candidates to be denied waitlisting compared with White candidates. The disparate application of these subjective criteria to the detriment of the candidacy of racially minoritized patients is an example of structural racism and is consistent with data from a broad range of health care scenarios demonstrating that implicit practitioner bias has detrimental impacts on the management and outcomes of minoritized patients …”

Racial disparities in incidence, treatment, and survival in adult brain metastases: a 10-year national database analysis

“…races. 6,[8][9][10][11] Other studies investigating racial differences in brain tumor survival have found a survival advantage in Black patients with brain tumors. [12][13][14][15] Because of the considerable variability in treatment recommendations for patients with metastatic brain lesions, it is imperative to understand how prognosis and survival may vary in different populations to ensure equitable care for vulnerable populations and reduce the overall financial burden on the healthcare system.…”