Conference Abstracts - Summit on Cancer Health Disparities (SCHD26)
Vol. 6, Issue Supplement 1, 2026 · S1-3
Prostate Cancer Disparities in Inpatient Outcomes Associated With Frailty and Race/Ethnicity: A Nationwide Analysis
Akshit Chitkara, MD,Rushin Patel, MD,Afoma Onyechi, MD,FNU Anamika, MD,Nikita Nikita, MD,Ana Maria Lopez, MD
Submission received: 2025-12-15 / Accepted: 2026-01-07 / Published: 2026-01-25
Abstract
Background
Disparities in prostate cancer outcomes are well documented, with Black and Hispanic patients experiencing higher mortality, delayed access to specialty care, and disproportionate hospitalization-related morbidity. Frailty is an important predictor of adverse outcomes in hospitalized patients and may amplify existing inequities by increasing vulnerability to inpatient complications and care fragmentation. However, the combined impact of frailty and race/ethnicity on inpatient prostate cancer outcomes has not been well characterized at a national level. We examined associations between frailty, race/ethnicity, and inpatient outcomes using a nationally representative dataset to identify targets for equity-focused improvement.
Methods
We conducted a retrospective analysis of the National Inpatient Sample from January to December 2020, identifying hospitalizations with a primary or secondary diagnosis of prostate cancer (ICD-10 C61.0, D07.5, Z85.46). Frailty was assessed using the Hospital Frailty Risk Score and categorized as low frailty (LFS) or intermediate–high frailty (IHFS). Multivariable logistic regression evaluated associations between frailty, race/ethnicity, and in-hospital mortality, adjusting for age, Charlson comorbidity index, median income by zip code, hospital bed size, teaching status, and census division. Secondary outcomes included length of stay (LOS) and total hospitalization cost.
Results
Among 51,980 prostate cancer hospitalizations, 72.7% were classified as IHFS. Patients with IHFS had higher unadjusted in-hospital mortality compared with LFS patients (5.85% vs. 1.2%). After adjustment, IHFS remained strongly associated with mortality (adjusted odds ratio [aOR] 4.45; 95% CI 3.80-5.22; p < 0.01). Racial and ethnic disparities persisted after adjustment: Hispanic patients had higher mortality odds compared with White patients (aOR 1.42; 95% CI 1.19-1.70; p < 0.01), and Black patients also demonstrated increased mortality risk (aOR 1.16; 95% CI 1.00-1.32; p = 0.037). IHFS was additionally associated with longer LOS (5.65 vs. 3.26 days) and higher total costs ($66,107 vs. $64,308).
Conclusion
Frailty and race/ethnicity are independently associated with worse inpatient outcomes among prostate cancer patients, with disproportionately higher mortality among Black and Hispanic individuals. These findings suggest that frailty may act as a clinical amplifier of existing structural inequities. Future work should focus on developing and testing frailty-informed, equity-focused inpatient strategies such as risk-triggered supportive care or enhanced navigation to reduce preventable morbidity, mortality, and hospitalization-related disparities.