Impact of sociodemographic factors on mortality among colorectal cancer hospitalizations: insights from a national representative sample

Purpose
Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide. While clinical predictors of outcomes are well established, the influence of sociodemographic variables on in-hospital mortality among CRC patients is less clearly defined. This study leverages a nationally representative database to assess how these factors affect outcomes in hospitalized CRC patients.
Methods
We conducted a retrospective cross-sectional analysis of the 2021–2022 National Inpatient Sample, identifying adult CRC hospitalizations using ICD-10-CM codes. Outcomes included in-hospital mortality and palliative care (PC) use, analyzed against sociodemographic and hospital factors via multivariable logistic regression.
Results
Among 100,064 adult CRC discharges, 11.8% (n=11,776) received PC during hospitalization. In-hospital mortality was 4.7% (n=4,692), with marked differences by PC receipt (23.6% with PC vs 2.2% without, p<0.001), reflecting end-of-life recognition rather than causality. Adjusted analyses showed PC utilization was higher among Black patients (aOR 1.29, 95% CI 1.21–1.38), women (aOR 1.07, 95% CI 1.03–1.12), those ≥85 years (aOR 1.76, 95% CI 1.55–1.99), and patients with Medicaid (aOR 1.52, 95% CI 1.41–1.65) or Medicare (aOR 1.21, 95% CI 1.12–1.31). Non-metro residence (aOR 0.77, 95% CI 0.71–0.83) and investor-owned hospitals were associated with lower PC use, while government (aOR 1.26, 95% CI 1.12–1.42) and private non-profit hospitals (aOR 1.31, 95% CI 1.20–1.44) had higher utilization. Mortality risk increased with age (≥85 years: aOR 2.67, 95% CI 2.19–3.25), Black race (aOR 1.17, 95% CI 1.06–1.30), and non-metro hospitals (aOR 1.24, 95% CI 1.13–1.36). Female sex (aOR 0.84, 95% CI 0.78–0.89), Medicare (aOR 0.79, 95% CI 0.71–0.81), and admission to government (aOR 0.79, 95% CI 0.67–0.92) or private non-profit hospitals (aOR 0.86, 95% CI 0.77–0.96) were protective, while other insurance types conferred higher mortality (aOR 1.43, 95% CI 1.25–1.63). Notably, although Black patients and women had higher odds of PC receipt, only women showed improved survival.
Conclusions
Palliative care use among hospitalized CRC patients varied significantly by race, sex, insurance, and hospital type. Despite higher PC utilization, Black patients had increased inpatient mortality, while non-metro hospitalizations were associated with both reduced PC access and worse survival. These findings underscore persistent inequities in CRC care despite observed patterns in palliative care utilization.