Outcomes for Medicaid recipients with multiple myeloma: A national retrospective trend analysis from 2015 to 2022

Abstract Introduction: Despite global decreases in overall cancer incidence, the incidence of multiple myeloma (MM) continues to increase at both national and global levels. Continued data collection on comorbid correlations remains essential for this unfortunately expanding population. We sought to examine the National Inpatient Sample database to describe in-hospital outcomes among Medicaid recipients with MM. Methods: Data were extracted from the National Inpatient Sample (NIS) Database from 2015 to 2022. The NIS was searched for hospitalizations of adult patients aged 18 years or older with MM. We then examined the outcomes of patients who were utilizing Medicaid insurance coverage. SPSS software was used for statistical analysis, multivariate logistic regression was used to adjust for confounders, and all results were powered to p0.001. The primary outcome was inpatient mortality, and secondary outcomes were annotated accordingly. Results: This study included 166,713 patients with MM, of whom 10,381 (6.23%) were Medicaid recipients. Multivariate regression demonstrated that patients with MM and Medicaid had higher inpatient mortality (OR 1.061, CI 1.055-1.067). On secondary analysis, Medicaid recipients with MM were more likely to have obesity (OR 1.073, CI 1.068-1.077), hypertension (OR 1.053, CI 1.052-1.055), diabetes mellitus (OR 1.103, CI 1.079-1.129), active smoking (OR 1.053, CI 1.050-1.055), Crohn's disease (OR 1.062, CI 1.041-1.083), ulcerative colitis (OR 1.047, CI 1.012-1.084), anemia (OR 1.066, CI 1.064-1.067), thrombocytopenia (OR 1.063, CI 1.059-1.066), deep vein thromboses (OR 1.074, CI 1.054-1.095), peripheral artery disease (OR 1.029, CI 1.025-1.033), chronic obstructive pulmonary disease (COPD; OR 1.063, CI 1.059-1.066), acute renal failure (OR 1.068, CI 1.066-1.071), severe liver disease (OR 1.092, CI 1.083-1.101), non-ST-segment myocardial infarction (NSTEMI; OR 1.047, CI 1.039-1.054), all-cause arrhythmias (OR 1.046, CI 1.042-1.050), all-cause shock (OR 1.070, CI 1.060-1.080), and vasopressors usage (OR 1.083, CI 1.070-1.095). Conclusions: In this nationally representative, population-based retrospective cohort trend analysis, Medicaid recipients with MM were associated with higher mortality and worse outcomes. This overall increase in morbidity burden may worsen MM outcomes due to potential treatment delays or diminished tolerance of high-intensity regimens. Ultimately, further investigation remains necessary to improve care for this potentially underserved patient population.