Racial disparities in in-hospital outcomes among patients with lung cancer receiving immune checkpoint inhibitors: A National Inpatient Sample analysis.

e23072 Background: Lung cancer is the second most common cancer and the leading cause of cancer-related mortality in the United States. Immune checkpoint inhibitors (ICI) are increasingly used in first line therapy in selected patients, with demonstrated improvements in survival. Despite advances in systemic therapy, inpatient hospitalizations due to ICI complications remain common. Prior studies have shown that African Americans experience worse cancer-related outcomes, in part due to social determinants of health. However, data evaluating race-based differences in inpatient outcomes among hospitalized patients with lung cancer receiving ICI are limited. This study examines racial differences in in-hospital outcomes among patients with lung cancer treated with ICI. Methods: We conducted a retrospective cohort study using the National Inpatient Sample database from 2015 to 2022. Patients with lung cancer of any stage who were hospitalized for ICI-related complications were identified. Inpatient outcomes were compared across racial groups. Multivariable logistic regression models adjusted for patient demographics, hospital-level factors, and comorbidity burden using the Elixhauser Comorbidity Index. Primary endpoint was in-hospital mortality. Secondary outcomes included ICI-associated complications and intensive care unit (ICU)-level therapies. Statistical significance was defined as a p < 0.001. Results: A total of 5,574 hospitalizations were studied. After multivariable adjustment, African American patients had higher in-hospital mortality than White patients (OR 1.1, CI 1.1 - 1.17). African Americans were associated with increased odds of admissions for ICI-related complications, including pneumonitis (OR 2.2, CI 2.0 - 2.04), colitis (OR 1.8, CI 1.6 - 2.0), carditis (OR 2.5, CI 2.2 - 2.8), transaminitis (OR 1.8, CI 1.7 - 2.0), anemia (OR 1.8, CI 1.7 - 1.8), acute kidney injury (OR 1.2, CI 1.1 - 1.8), and arrhythmias (OR 1.2, CI 1.1 - 1.2). African Americans were more likely to experience ICU-level therapies, including shock (OR 1.1, CI 1.0 - 1.2), vasopressors (OR 1.1, CI 1.1 - 1.2), mechanical ventilation (OR 1.1, CI 1.1 - 1.2), and continuous renal replacement therapy (CRRT) (OR 1.2, CI 1.1 - 1.2). (all p < 0.001). Conclusions: In this cohort study, African American patients hospitalized with lung cancer receiving ICIs experienced significantly worse in-hospital outcomes than White patients. These findings highlight persistent racial disparities in inpatient clinical outcomes despite advances in treatment and ICI management. Further, these results underscore the need for targeted interventions, improved risk stratification, and investigation into the structural and clinical factors contributing to these disparities. Future work should focus on identifying actionable drivers to improve equity in outcomes.