Neurological Comorbidity Burden, Outcomes, and Disparities in Head and Neck Cancer During COVID-19.

Overview

1. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
2. Division of Hematology and Oncology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
3. City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
4. Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
5. Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
6. Carol and Ray Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT 06030, USA

Abstract

Background: Neurological complications (NCs) are increasingly recognized as contributors to adverse outcomes in hospitalized cancer populations, yet their burden and associated disparities in patients with head and neck cancer (HNC) remain poorly characterized. This study evaluated the association between NCs and hospital outcomes in HNC and examined sociodemographic disparities. Methods: A retrospective cross-sectional study was conducted using the 2021 National Inpatient Sample, a nationally representative database of U.S. hospitalizations. Adult patients with a primary diagnosis of HNC were included. NCs were identified using ICD-10-CM codes. Survey-weighted multivariable regression models assessed associations with outcomes. Results: Among 57,615 weighted HNC hospitalizations, corresponding to 11,523 unweighted discharges, 6320 (unweighted n = 1328; 11%) had at least one NC. NCs were independently associated with higher hospital charges (adjusted geometric mean ratio [aGMR], 1.38, 95% CI 1.26–1.51), longer length of stay (aGMR, 1.25, 95% CI 1.17–1.34), and increased in-hospital mortality (aOR 2.42, 95% CI 1.96–2.98). NCs were also associated with higher odds of hospital-acquired complications (aOR 1.92), septicemia (1.90), fluid and electrolyte disorders (1.65), COVID-19 infection (1.66), and emergency department admission (1.33). Disparities were observed, with Hispanic and Other race patients incurring higher charges and Black and Hispanic patients experiencing longer hospital stays; Medicaid and self-pay patients had higher mortality compared with those on Medicare. Conclusions: NCs are associated with worse outcomes and increased healthcare utilization among hospitalized HNC patients; however, given NIS limitations, including lack of cancer stage, treatment history, performance status, and brain metastasis data, these findings should be interpreted as non-causal associations. Early NC recognition and disparity-focused interventions may improve inpatient cancer care.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Data Availability Statement

The analysis used 2021 National Inpatient Sample (NIS) data available from the HCUP Central Distributor (https://www.hcup-us.ahrq.gov/, accessed on 15 April 2026), subject to the data use agreement and fee. Analysis code and derived outputs are available from the corresponding author upon reasonable request.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Version 1, 27 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 7 authors, 6 keywords, 1 funder, 42 references.

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This paper

Dhimal, N., Pili, R., Epstein, J. B., Satheeshkumar, V., Ponnamma Mohan, M., Meleveedu, K., & Satheeshkumar, P. S. (2026). Neurological Comorbidity Burden, Outcomes, and Disparities in Head and Neck Cancer During COVID-19. Reports (MDPI), 9(3), 218. https://doi.org/10.3390/reports9030218

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