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

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.