Emergency department visits and hospitalizations in cancer survivors with disabilities: A national analysis.

1643 Background: One in four Americans has a disability. Adults with disabilities are known to have a higher cancer burden than the general U.S. population, but the healthcare utilization patterns and needs of this population remain understudied. We examined factors associated with emergency department (ED) visits and hospitalizations among cancer survivors, with a focus on disability status. Methods: We used National Health Interview Survey (NHIS) data from 2022-2024. Adults aged 18+ years who self-reported a diagnosis of breast, prostate, or colon cancer were included. Our key explanatory variable was disability status, defined by receipt of Supplemental Security Income or Social Security Disability Insurance, or a positive designation using the Washington Group Short Set Composite Disability Indicator. The primary outcomes were ED visits and hospitalization in the past 12 months. Logistic regression models adjusted for demographics and health status (e.g., body mass index, self-rated health, and smoking status). All analyses incorporate NHIS survey weights to account for the complex survey design. Results: Our sample included 4,179 NHIS respondents with breast, prostate, or colorectal cancer; 999 (23.9%) had a disability. Cancer survivors with disabilities were more likely to have less than a high school education (19.7% vs 9.2%), be enrolled in Medicaid (6.0 vs 2.7%) or Medicare (49% vs 44.8%), and report poor health status (22.3% vs 3.6%) compared to those without disabilities. Compared to cancer survivors without disability, those with disability had higher odds of ED visits (aOR 1.59 95% CI 1.27-1.99, p<0.001) and hospitalizations (aOR 1.70 95% CI 1.30-2.22, p<0.001). Other factors associated with increased odds of ED visits in cancer survivors were region (Ref=Northeast, South: aOR 1.33 95% CI 1.01-1.77, p=0.046; West: aOR 1.46 95% CI 1.09-1.98, p=0.01), Medicaid insurance (Ref=no insurance, aOR 1.93 95% CI 1.01-3.69, p=0.046), and poor self-rated health (Ref=excellent, aOR 6.69 95% CI 4.05-11.07, p<0.001). Factors associated with increased odds of hospitalizations in cancer survivors were Medicare (Ref=no insurance, aOR 2.18 95% CI 1.21-3.92, p=0.01), private insurance (Ref=no insurance, aOR 1.83 95% CI 1.02-3.26, p=0.04), multiple insurance (Ref=no insurance, aOR 2.07 95% CI 1.15-3.74, p=0.02), and poor self-rated health (Ref=excellent, aOR 6.96 95% CI 3.82-12.70, p<0.001). Conclusions: We observed an independent association between disability and ED visits and hospitalizations among cancer survivors in a national, population-based dataset. Geographic region, insurance, and poor health perception were additional risk factors for acute care utilization in cancer survivors. Our findings highlight the need for targeted interventions to improve ambulatory care access and reduce preventable acute care utilization in this vulnerable population.