Multilevel correlates of inhospital mortality among head and neck cancer patients

Transcription

1 Multilevel correlates of inhospital mortality among head and neck cancer patients Eric Adjei Boakye, MA 1, Nosayaba Osazuwa-Peters, BDS, MPH, CHES 2, Betelihem B Tobo, MPH 1, Christian J Geneus, MS, MPH 3, Kahee A Mohammed, MD, MPH 1, Thomas Burroughs, PhD 1, Mark A Varvares, MD, FACS 4 1 Saint Louis University Center for Outcomes Research (SLUCOR) 2 Saint Louis University Cancer Center 3 Tulane University 4 Harvard University

2 Conflicts of Interest None 2

3 Background Head and neck cancer (HNC) accounts for 3% of all new cancer cases in the USA It is estimated that 61,760 individuals will be diagnosed with HNC in ,190 will die from HNC 3

4 Background Risk factors for in-hospital mortality among cancer patients are multifaceted Previous studies have focused on only patient-level characteristics There is a paucity of research exploring multilevel correlates of in hospital mortality 4

5 Objective Examine the multilevel effects of patient- and hospital-level factors on in-hospital mortality among patients diagnosed with head and neck cancer 5

6 Methods - Data Nationwide Inpatient Sample (NIS) ,984 hospital records with a diagnosis of head and neck cancer (ICD-9 Codes) 6

7 Methods - Measures Dependent variable: In-hospital mortality Independent variables: Patient-level (age, sex, race, insurance payer, household income, comorbidity score, metastatic cancer, admission day) Hospital-level (census region, bed size, teaching status) 7

8 Statistical Analysis Tests Descriptive statistics & multilevel logistic regression Statistical significance P < 0.05 Statistical program SAS survey procedures 8

9 Results In-hospital mortality rate: 3.9% Mean *LOS: 6.7 days Mean age: 62 years Mean Comorbidity score: 2.8 *LOS = length of stay 9

10 Prevalence of HNC by anatomic sites 30% 25% 26% 20% 15% 10% 5% 0% 15% 10% 9% 7% 6% 6% 5% 5% 4% 3% 3% 1% 10

11 Distribution of mortality by anatomic site 30% 27% 25% 20% 15% 10% 5% 0% 15% 12% 10% 7% 6% 6% 6% 5% 3% 1% 1% 1% 11

12 Result - Sociodemographics Adjusted Odds Ratio (95% Confidence Interval) Age in years 1.02 ( ) Sex Female Ref Male 1.25 ( ) Race Caucasian African American Other Payer Private Medicare Medicaid Other Ref 0.99 ( ) 1.15 ( ) Ref 0.85 ( ) 1.01 ( ) 1.57 ( ) 12

13 Result Comorbidity and Others Adjusted Odds Ratio (95% Confidence Interval) Elixhauser comorbidity score 1.18 ( ) Metastatic Cancer No Yes Admission On weekday On weekend Ref 1.47 ( ) Ref 1.54 ( ) 13

14 Result Hospital characteristics Region Northeast Midwest West South Teaching Status Teaching Non-Teaching Bed Size Large Medium Small Adjusted Odds Ratio (95% Confidence Interval) Ref 0.72 ( ) 0.81 ( ) 0.82 ( ) Ref 1.67 ( ) Ref 1.17 ( ) 1.09 ( ) 14

15 Summary of main findings Factors associated with in-hospital mortality: Patient-level: older age, men, advanced comorbidities, metastatic cancer, admission on weekend Hospital-level: admission to a nonteaching hospital 15

16 Limitations Residual confounding stage of cancer, tumor size and treatment modalities were unavailable to adjust for Cross sectional design 16

17 Implications Both patient-level and hospital-level characteristics are critical indicators of survivorship Future research should adjust for cancer stage and treatment modalities 17

18 Co-authors Acknowledgements NAACCR Program Chairs and Coordinators 18

19 References American Cancer Society. Cancer reference information oral cavity and oropharyngeal cancer; laryngeal cancer Healthcare Cost and Utilization Project (HCUP). Nationwide Inpatient Sample. Rockville, MD: Agency for Health Care Policy and Research. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998; 36:8-27. Allareddy V, Konety BR. Characteristics of patients and predictors of in-hospital mortality after hospitalization for head and neck cancers. Cancer. Jun ;106(11): Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993;329: Kelz RR, Gimotty PA, Polsky D, Norman S, Fraker D, DeMichele A. Morbidity and mortality of colorectal carcinoma surgery differs by insurance status. Cancer. 2004;101: Roetzheim RG, Pal N, Gonzalez EC, Ferrante JM, Van Durme DJ, Krischer JP. Effects of health insurance and race on colorectal cancer treatments and outcomes. Am J Public Health. 2000;90:

20 THANK YOU! QUESTIONS 20