COVID-19 infection impact on race and clinical outcome of patients with breast cancer: A nationwide analysis.

16 Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females worldwide. Recent data showed the detrimental effects of COVID-19 infection on other neoplasm conditions, causing increased mortality rates and complications. However, limited information exists on the specific impacts of COVID-19 infection in patients hospitalized for breast cancer, as well as racial impact differences. Methods: We analyzed the 2020 U.S. National Inpatient Sample (NIS) to investigate the effects of COVID-19 infection on cases primarily admitted due to breast cancers. Adjusted odds ratios (aORs) for specified outcomes were calculated through multivariable logistic and linear regression analyses. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Statistical significance was established at a p-value of 0.05. Results: We identified 25,559 patients with a primary discharge diagnosis of breast cancer. The mean age was 59.7 years; 99.28% were female. In the non-COVID group, Caucasians accounted for 60%, followed by African Americans (19%). However, in the COVID-19 group, African Americans predominated with 41%, followed by Caucasian (35%) (p-value = 0.05). Of these, 0.52% (85/25,559) had a concurrent diagnosis of COVID-19 infection. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 6.07; 95% CI (1.26, 29.13), p = 0.024), higher mean length of stay(b 5.22; 95% CI (2.08,8.36) p =0.001), acute respiratory failure (aOR 4.88; 95% CI (1.51, 15.77), p = 0.008), coagulopathy (aOR 8.38; 95% CI (2.19, 32.02), p=0.002) and SIRS (aOR 6.38; 95% CI (1.25, 32.50), p = 0.026). We observed non-significant, but increased, risks of acute kidney injury (AKI), shock, and sepsis, as well as total hospitalization costs in COVID-19-positive patients. Conclusions: In conclusion, our study underscores that COVID-19 infection is associated with higher in-hospital mortality and other clinical outcomes in breast cancer patients, as well as, a disproportionated impact against some races. Future longitudinal studies are warranted to comprehensively assess the causation of these clinical outcomes in this population.