Social Determinants of Health and the Risk of Perforation, Peritonitis, and Sepsis in Gastrointestinal Malignancies: A National Inpatient Sample Analysis

Document Type

Conference Proceeding

Publication Date

3-30-2026

Publication Title

Br J Hosp Med

Keywords

adult, age, cancer localization, cancer mortality, Caucasian, cohort analysis, colorectal cancer, conference abstract, controlled study, esophagus cancer, female, gastrointestinal cancer, Hispanic, hospital charge, hospitalization, human, ICD-10, length of stay, lowest income group, major clinical study, male, medicaid, medicare, mortality, outpatient, pancreas cancer, perforation, peritonitis, retrospective study, sepsis, septic shock, small intestine, small intestine cancer, social determinants of health, social status, subacute care, surgery

Abstract

Background: Gastrointestinal (GI) malignancies are a leading cause of cancer mortality accounting for ~28% of cancer deaths in the U.S. [1]. Perforation, peritonitis, and septic shock are severe complications often presenting later in the disease course and associated with surgery, prolonged hospitalization, and mortality [2]. Social determinants of health (SDOH) including race, socioeconomic status, and insurance are linked to advanced stage diagnosis, higher rates of emergency presentations, and worse survival [3]. Limited data details how SDOH influence the risk of perforation, peritonitis, and sepsis among patients with established GI cancers or how they affect in‐hospital outcomes. We evaluated SDOH‐associated differences in these complications and examined their impact on inpatient mortality and resource utilization. Methods: Using the National Inpatient Sample (2018–2021), we conducted a retrospective study and identified adults ≥ 18 years with GI malignancies via ICD‐10 codes and categorized them as esophageal, gastric, small bowel, colorectal, hepatobiliary, pancreatic, or Other GI cancers. Primary outcomes were inpatient perforation/ peritonitis and sepsis/septic shock. Predictors included age, sex, race, insurance, income, and cancer site. Secondary outcomes were length of stay (LOS), hospital charges, and discharge disposition. Survey-weighted regression generated adjusted odds ratios (aORs) with 95% CIs using White race, Medicare, lowest income quartile, and esophageal cancer as references. Results: Black and Hispanic patients had lower odds of perforation/peritonitis (15% and 13%), while Medicaid and self‐pay had higher odds (24% and 18%). All cancer sites except hepatobiliary demonstrated increased risk, highest in small‐bowel cancers (346%). For sepsis, Black, Hispanic, Asian, and Other groups had higher odds (14–34%), while private insurance and no‐charge encounters had lower odds (12% and 59%). Septic shock results paralleled sepsis. Longer LOS was associated with Black, Hispanic, Asian, and Other groups (all p < 0.05), Medicaid and self‐pay (p ≤ 0.001), lower income (p < 0.001), female sex (p < 0.001), older age (p < 0.001), and stomach, small‐bowel, hepatobiliary, pancreatic, and other GI cancers (p ≤ 0.01). Shorter LOS occurred with private insurance, higher-income quartiles, and colorectal cancer (all p < 0.001). Hospital charges were higher for Black, Hispanic, Asian, and Other groups (p < 0.05), lower across all payer groups (all p ≤ 0.001), increased with income (p < 0.001), and were higher in small‐bowel, colorectal, stomach, and other GI cancers, but lower in hepatobiliary and pancreatic cancers (all p ≤ 0.01). Discharge to a facility was more likely among Black patients and those with higher income (p < 0.001) and less likely among Hispanic, Asian, and Other groups (p < 0.001). All payer groups had lower odds (p < 0.001), and all malignancies had lower odds of facility care (p < .002). Conclusions: SDOH influence the outcomes of acute complications in GI malignancies. Insurance, income, and race were associated with differing risks of perforation, peritonitis, sepsis/septic shock, and variation in resource use and post‐acute care requirements. Furthermore, structural factors contribute to life‐threatening complications and hospitalization outcomes. Targeted interventions that reduce diagnostic delays, expand outpatient oncology access, and address financial/geographic barriers are essential to reducing inequities and improving inpatient outcomes.

Volume

21

First Page

S722

Last Page

S724

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