Rural-urban disparities in demographics, clinical characteristics, and hospitalization burden among young non-smoking adults with lung cancer in the United States.

e20645 Background: Recent reports indicate a rise in lung cancer incidence among young non-smokers, yet rural-urban differences in patient characteristics and potential gaps in availability of resources remain poorly understood. We sought to investigate rural-urban differences in early-onset lung cancer patients via a national database. Methods: We analyzed hospitalization data from the National Inpatient Sample (2016-2022) for young adults (ages 18-50) hospitalized with lung cancer. We first determined the prevalence of smoking among all young lung cancer patients. Subsequently, we restricted our analysis to non-smokers and compared baseline demographics and hospitalization burden between those admitted to rural versus urban centers. Hospital charges were adjusted for inflation using appropriate survey weighting methodology. Results: Among 97, 855 young adults hospitalized with lung cancer, 60. 62% were smokers. Smokers were slightly older than non-smokers (mean age 45. 41 vs 43. 30 years). Among the 38, 535 non-smokers, only 4. 07% (n=1, 570) were treated at rural centers, with the remainder at urban hospitals (n=36, 965). Rural patients were older (44. 75 vs 43. 24 years, p<0. 001), more likely to be White (79. 28% vs 50. 42%, p<0. 001), and had higher rates of diabetes (19. 43% vs 12. 50%, p=0. 0007) and prior myocardial infarction (2. 23% vs 0. 95%, p=0. 0243). Notably, rural patients demonstrated nearly four-fold higher suicidality (1. 91% vs 0. 51%, p=0. 0013) despite comparable rates of depression (10. 83% vs 9. 74%, p=0. 5316) and opioid use (3. 19% vs 2. 31%, p=0. 3176). Rural centers had fewer cases with metastatic disease (57. 32% vs 67. 69%, p=0. 0002) and lower utilization of palliative care (11. 15% vs 17. 98%, p=0. 0035). Rural hospitalizations were significantly shorter (4. 76 vs 6. 96 days, p<0. 001) with markedly lower charges (45, 300 vs 112, 080, p<0. 001). Conclusions: Young non-smoking lung cancer patients at rural centers demonstrate distinct demographic profiles and concerning mental health disparities, particularly elevated suicidality. The significantly shorter hospital stays and lower charges at rural facilities, coupled with reduced palliative care utilization, suggest potential gaps in access to comprehensive oncologic and supportive care services. These findings underscore the urgent need for improved mental health screening and enhanced oncology resources in rural healthcare settings.