Abstract
Introduction Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL), accounting for 25-30% of all cases. Despite significant advances in chemoimmunotherapy, it remains an aggressive malignancy with considerable morbidity. As therapeutic advances continue and the population continues to age, hospitalization rates and associated inpatient complications have also increased. Various studies show that race and sociodemographic factors can affect hospitalization outcomes in general. However, the correlation between these factors and inpatient outcomes in DLBCL remains underexplored. This study aims to evaluate the correlation between race, sociodemographic characteristics, and hospitalization outcomes in patients with DLBCL.
Methods We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2020 to 2022 to identify hospitalizations with a principal or secondary diagnosis of DLBCL among adults (age ≥18 years) in the United States (U.S.). All analyses accounted for the complex survey design using survey-weighted (SVY) methods to produce nationally representative estimates. The primary outcomes included in-hospital mortality, length of stay, disposition (routine discharge to home vs. transfer to a facility or home with healthcare services), and total hospital charges. Patients were stratified by race/ethnicity into four groups: White (reference group), Black, Hispanic, and Other. Multivariate regression models were used to analyze the impact of race on inpatient outcomes after adjusting for age, sex, primary insurance payer, median household income by ZIP code, hospital characteristics, and the Charlson Comorbidity Index.
Results A total of 217,390 DLBCL hospitalizations were identified from 2020 to 2022. Of these, 70.2% were White, 8.1% Black, 11.3% Hispanic, and 10.3% Other. A higher proportion of Black (60.6%) and Hispanic (57.4%) patients were under the age of 65, compared to White (36.1%) and Other (46.4%). Females comprised 41.4% of White, 44.0% of Black, 43.6% of Hispanic, and 44.8% of Other. Socioeconomic disparities were evident; 45.1% of Black patients and 30.7% of Hispanic patients resided in the lowest income quartile, compared to 18.7% of White and 14.4% of Other. Medicare was the most common primary payer across all groups, covering 61.6% of White, 41.5% of Black, 40.1% of Hispanic, and 47.2% of Other. However, Medicaid coverage was significantly higher among Black (21.8%) and Hispanic (24.2%) patients. Most admissions were non-elective and occurred at large urban teaching hospitals, and discharge to home was the most common disposition across all racial groups. High comorbidity burden (Charlson Comorbidity Index ≥3) was observed in most patients; 63.6% of White, 70.6% of Black, 65.1% of Hispanic, and 62.1% of Other. Unadjusted in-hospital mortality rates were similar: 5.4% in White, 5.7% in Black, 6.0% in Hispanic, and 5.8% in Other. However, adjusted analyses revealed significantly higher odds of in-hospital mortality among Hispanic (OR 1.25, p=0.002) and Other (OR 1.23, p=0.006). At the same time, there were non-significantly high odds of inpatient mortality in Black (OR 1.18, p=0.050) compared to White. Prolonged length of stay was more likely in Black (OR 1.16, p<0.001) and Hispanic patients (OR 1.15, p<0.001). Black patients had higher odds of discharge to a facility/ need of home health (OR 1.25, p<0.001), whereas Hispanic patients had lower odds (OR 0.90, p=0.019). Adjusted total hospital charges were significantly higher for Hispanic (β = $18,030, p=0.010) and Other (β = $17,145, p=0.011) patients, but not significantly different for Black patients (β = –$4,716, p=0.437).
Conclusion In this nationally representative cohort of DLBCL patients, race and sociodemographic factors significantly influenced hospitalization characteristics and adjusted outcomes. Although crude in-hospital mortality rates were similar across racial groups, multivariate analysis revealed higher odds of mortality among Hispanic and Other race patients. Additionally, Black and Hispanic patients had higher odds of prolonged hospital stay, with Black patients also more likely to be discharged to a facility. These disparities were accompanied by a greater comorbidity burden and socioeconomic disadvantage, particularly among Black patients. The findings highlight the importance of addressing structural and clinical contributors to inequity in DLBCL inpatient care.
