P-311 Beyond the binary: Analysis of esophageal cancer hospitalizations in the transgender population in United States

Transgenders are individuals with a gender identity that differs from their sex at the time of birth. Over > 1.6 million adults identify themselves as transgender in the US, of which 39% are women and 36% are men. While gender differences in cancer prevalence have been well established between men and women, very few studies evaluate the prevalence of cancer in patients who identify as transgender people. We aimed to evaluate the trends of esophageal cancer admission hospitalizations in the transgender population compared to the general population. This was a retrospective analysis of the data obtained from the Nationwide Inpatient Sample database. Data were sampled from 2015 to 2020 utilizing the ICD-10 codes of esophageal cancer and patients (>18 years) who identified as transgender. The primary outcome was in-hospital mortality. Secondary outcomes were the length of stay and total costs in the hospital, respectively. A multivariate logistic regression analysis was used to estimate the odds ratio. A total of 212,425 patients with esophageal cancer were admitted between 2015- 2020, of which 97,950 were transgender. The mean age was 33 vs. 34 years in the general population. Both groups were predominantly Caucasian (65% vs. 68%), followed by African Americans (15.2% vs. 5.2%). Median household income in transgender people was commonly in the lower quartile (27.8%). In cisgender patients, 37% had a median income in the 26th-50th percentile followed by 26% in the 76th-100th percentile. Inpatient mortality in transgender patients with esophageal cancer was 5.1 times more (95% CI: 1.8-8.3, p < 0.05). The average length of stay was higher in the transgender population by 2.15 days (95% CI: 1.1-3.1, p < 0.05). Increased length of stay in teaching hospitals by 1.3 days (95% CI: 1.08- 1.59, p < 0.001) and larger hospitals by 1.4 days (95% CI: 0.51- 2.28, p < 0.001) was observed. The total cost of admission was significantly different in teaching hospitals at $27,774 (95% CI: $23,353.35 - $ 32,195.96, p < 0.001). We found a significant difference between the inpatient outcomes of transgender and the general population. Despite the markedly low representation of transgender people in the national cancer registries, they experienced an increased mean length of stay and mortality compared to cisgenders with esophageal cancer. Further investigation is required to determine the cause of disparity in healthcare utilization amongst the gender-diverse population.