Disparities in surgical access and outcomes among lung cancer patients: A National Inpatient Analysis.

209 Background: Surgical resection is the cornerstone of treatment for early-stage non-small cell lung cancer (NSCLC). However, disparities persist in access to surgery and outcomes across racial, socioeconomic, and institutional lines. This study evaluates the impact of race/ethnicity, insurance status, and hospital characteristics on surgical access, complication rates, and in-hospital mortality. Methods: We analyzed the 2016–2020 Nationwide Inpatient Sample (NIS), identifying adults (≥18 years) with a primary diagnosis of lung cancer. Outcomes included rates of surgical resection, postoperative complications, and inpatient mortality. Multivariable logistic regression models, adjusted for demographics, comorbidities, insurance type, and hospital characteristics, were used to identify predictors of treatment and outcomes. Postoperative complications were defined using ICD-10 codes for respiratory failure, infections, and procedural sequelae. Analyses were survey-weighted and statistical significance was set at p < 0.05. Results: Among an estimated 2 million patients, 77% were White, 13% Black, and 5% Hispanic. After adjustment, factors associated with increased odds of undergoing surgery included female sex (OR 1.11, p < 0.001), higher income (Q4 vs Q1: OR 1.24, p < 0.001), urban hospital location (OR 1.91, p < 0.001), teaching hospital status (OR 2.18, p < 0.001), and large hospital bed size (OR 2.33, p < 0.001). Black race (OR 0.63, p < 0.001), Medicaid (OR 0.47, p < 0.001), and self-pay status (OR 0.38, p < 0.001) were associated with lower odds of surgical intervention. Postoperative complications were more likely with advanced comorbidities (Charlson category 3: OR 1.76; category 4: OR 1.57; p < 0.001) and increasing age (OR 1.01 per year, p < 0.001). Black and Hispanic patients had lower adjusted odds of complications (ORs 0.82–0.89, p < 0.001). Teaching hospitals were protective (OR 0.84, p < 0.001), while urban hospitals were associated with increased risk (OR 1.10, p < 0.001). Mortality risk was elevated with higher comorbidity burden (category 3: OR 1.11, p = 0.002; category 4: OR 2.09, p < 0.001), older age (OR 1.01 per year, p < 0.001), and male sex (female OR 0.84, p < 0.001). Black (OR 1.05, p = 0.005) and other non-White groups (OR 1.16–1.23, p < 0.001) had modestly higher mortality. Higher income (Q4: OR 0.87, p < 0.001), private insurance (OR 0.67, p < 0.001), and treatment at urban (OR 0.91, p = 0.001) or teaching hospitals (OR 0.96, p = 0.026) were protective. Conclusions: Significant disparities in surgical access and outcomes persist among lung cancer patients. Race, insurance coverage, hospital characteristics, and socioeconomic status independently influence treatment likelihood, complication rates, and mortality. Targeted interventions are warranted to promote equity in lung cancer care.