Sex disparities in cardio-oncology treatment and mortality: Propensity score nationally representative case-control analysis with machine learning augmentation of over 30 million hospitalizations
Presenter
Jin wan Kim, MD, University of Texas Houston Health Science Center, Houston, TX
Jin wan Kim, MD1, Dominique J Monlezun, MD, PhD, PhD, MPH2, Nicolas Palaskas, MD2, Mehmet Cilingiroglu, MD, FSCAI3, Konstantinos Marmagkiolis, MD, MBA, FSCAI4 and Cezar A. Iliescu, MD, FSCAI2, (1)University of Texas Houston Health Science Center, Houston, TX, (2)Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)Arkansas Heart Hospital, Little Rock, AR, (4)Premier Heart and Vascular Center, Zephyrhills, FL
Keywords: Acute Coronary Syndromes (ACS), Cardio-oncology and Coronary
Background:
The association between sex disparities and percutaneous coronary intervention (PCI) for patients with cancer versus non-cancer is unclear. As the benefit of PCI in cancer patients becomes better quantified, characterizing the social disparities within this population will enable steps toward providing equitable care.
Methods:
Propensity score adjusted multivariable regression for mortality was performed in this case-control study of the United States’ largest all-payer hospitalized dataset, the 2016 National Inpatient Sample. Regression models by PCI and sex weighted by the complex survey design were fully adjusted for age, race, income, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), acute coronary syndrome (ACS), and the likelihood of undergoing PCI. Model optimization with conducted with forward and backward stepwise regression, standard regression diagnostics, and performance comparison to backward propagation neural network machine learning (ML) according to root mean squared error (RMSE).
Results:
Of the 4,659,200 hospitalized adult cancer patients, females were less likely than males to have ACS (41.52% versus 58.48%), though they were less likely to undergo PCI even if they had ACS (37.86% versus 62.14%) and mortality risk matched to males for minor, moderate, and extreme risk (all p<0.001). In the 30,195,722 hospitalized adult patients overall, fully adjusted regression stratified by cancer and sex status found greater mortality reductions with PCI for males (OR 0.66, 95%CI 0.63-0.69; p<0.001) versus females (OR 0.72, 95%CI 0.68-0.76; p<0.001) without cancer. Mortality reductions were even greater for PCI among males (OR 0.56; 95%CI 0.50-0.62; p<0.001) versus females (OR 0.61; 95%CI 0.53-0.69; p<0.001) with cancer. ML analysis produced comparable model performance by RMSE.
Conclusions:
This large nationally representative study suggests that females are less likely to undergo PCI and survive versus males among cancer patients; additional research is required to optimize sex equities in treatment access and outcomes.