Background: Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the United States (US). Previous studies have shown that men with prostate cancer in rural areas of the US tend to have lower screening rates and higher mortality. However, data on regional variations in in-hospital outcomes for prostate cancer within the US is limited. This study aims to analyze these variations and the potential disparities contributing to them using a national database. Methods: We utilized the National Inpatient Sample (NIS) database from 2016 to 2020 and identified all adult hospitalizations with prostate cancer. Geographical location of the hospitals were stratified to North-east, Mid-west, South and West. North-east was taken as the reference. Multivariate regression was used to analyze the impact of geography on in-hospital outcomes of prostate cancer after adjusting for age, gender, insurance, hospital characteristics and Charlson comorbidity index. Results: A total of 277,711 prostate cancer hospitalizations were identified, with 36% occurring in the South, 23% in the Midwest, 21% in the Northeast, and 20% in the West. Compared to the Northeast, the Midwest and South had significantly lower odds of mortality and resource utilization, but higher odds of complications like urinary tract infections and venous thromboembolism (Table). Further analysis revealed that Midwest and South had a higher proportion of patients in higher income quartiles with private insurance. The racial breakdown showed that 79% of patients in the South and 68% in the Midwest were White, while the Northeast had a more diverse population, with 47% white, 25% Black and 17% Hispanic patients (p<0.001). Irrespective of region, most sought care in urban teaching hospitals with large bed size (p=0.03). Conclusions: This study highlights significant regional disparities in in-hospital outcomes for prostate cancer, influenced by race and income. The higher prevalence of White patients in the South and Midwest, coupled with higher income and greater access to private insurance, may contribute to these variations. Understanding these geographical differences can provide insights into how local healthcare access and socioeconomic factors affect outcomes, enabling tailored treatment strategies to improve survival rates. Further research is needed to explore the underlying mechanisms behind these disparities.
EPR25-136: TABLE. Multivariate regression analysis showing geographic variations in outcomes, and healthcare utilization of prostate cancer patients in the NIS (2016–2020)
