Regional, and hospital-level disparities in mortality and ICU-level care among hospitalized peripheral T-cell lymphoma patients: Insights from the 2022 national inpatient sample Free

Background Peripheral T-cell lymphomas (PTCL) are a rare and aggressive subtype of non-Hodgkin lymphoma with poor overall survival and limited treatment options. The ALK-positive subtype of anaplastic large cell lymphoma (ALCL) is known to have the most favorable prognosis, with the highest overall and progression-free survival rates, whereas other subtypes have a median overall survival of approximately 12–36 months. Although most diagnoses are made in the outpatient setting, the aggressive nature of PTCL often leads to inpatient admissions for advanced care. We conducted a disparities-focused observational study using the 2022 National Inpatient Sample (NIS) to explore how region, hospital characteristics, disease subtype, and insurance status relate to in-hospital mortality and ICU-level care among patients with peripheral T-cell lymphoma

Methods We used ICD-10-CM codes to identify hospitalizations for peripheral T-cell lymphoma, including PTCL-not elsewhere classified(NOS)(C84.4), Anaplastic large cell lymphoma, ALK-positive (C84.6), Anaplastic large cell lymphoma, ALK-negative (C84.7), Other mature T/NK-cell lymphomas (C84.Z, C84.9, C86). We extracted patient insurance payer, hospital region (Northeast, Midwest, South, West), and hospital teaching status (rural, urban non-teaching, urban teaching).

Results We identified a total of 8,865 peripheral T-cell lymphoma hospitalizations in 2022. The cohort included 36% with PTCL-NOS (n = 3,190), 43% with other specified or unspecified T-cell lymphomas (n = 3,825), 11% with ALK-positive ALCL (n = 1,015), and 9% with ALK-negative ALCL (n = 835). The overall in-hospital mortality rate was 8%. Outcomes differed by subtype: ALK-positive ALCL patients had a significantly lower mortality (~0.6% in-hospital death) compared to all other subtypes (mortality ~6–10%), consistent with its favorable prognosis. In-hospital mortality did not vary by region of the hospital (p = 0.31) or hospital teaching status (p = 0.80) but by insurance type (p < 0.01): patients with Medicaid had the highest in-hospital mortality (~10%), nearly double that of privately insured patients (~5%)(p < 0.01). ICU-level care was required in approximately 10% of hospitalizations. ICU utilization also varied significantly by payer (p < 0.001): uninsured/self-pay patients had the highest rate (13%), followed by Medicare (12%), private insurance (10%), and Medicaid (9%). The frequency of inter-hospital transfer – patients arriving as transfers from another acute care hospital – varied by region (p = 0.01). The Southern region had the highest transfer-in rate (12%), compared to 6% in the Northeast and 9% in the Midwest and West. Additionally, hospital teaching status was associated with transfer patterns (p < 0.0001): only ~2% of patients at rural non-teaching hospitals were transfers, compared to ~14% at urban teaching hospitals.

Conclusions Our national inpatient analysis reveals important disparities in the care and outcomes of peripheral T-cell lymphoma patients. While in-hospital mortality for T-cell lymphoma did not significantly differ by geographic region or hospital type – suggesting that once hospitalized, short-term clinical management is comparable, disparities were associated with insurance status. Patients with Medicaid had substantially higher in-hospital mortality than privately insured patients ICU-level care needs also differed by payer, with the highest utilization among uninsured patients—suggesting delayed access to care or more critical illness at presentation. Additionally, we found that patients in certain regions (particularly the South) and those initially at non-teaching or smaller hospitals were more likely to require transfer to larger centers. This suggests regional and hospital-level gaps in the management of peripheral T cell lymphoma patients, potentially impacting the timeliness of optimal care. Our findings underscore the need to reallocate resource for earlier diagnosis of peripheral T cell lymphoma regardless of insurance type and strengthen referral networks. Our findings show the need to improve early diagnosis of peripheral T-cell lymphoma across all insurance types and to strengthen referral networks.