Impact of racial disparities and insurance status in patients with bone sarcomas in the USA: a population-based cohort study

Bone & Joint Research

article

Xianglin Hu¹  Tomohiro Fujiwara²  Matthew T. Houdek³  Lingxiao Chen⁴  Wending Huang¹  Zhengwang Sun¹  Yangbai Sun¹  Wangjun Yan¹ 

[1] Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center;Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences;Department of Orthopaedic Surgery, Mayo Clinic;Faculty of Medicine and Health, University of Sydney, The Kolling Institute

关键词: Bone sarcoma;    Cancer disparity;    Racial disparities;    Insurance;    Health equality;    bone sarcomas;    cancers;    Chondrosarcomas;    metastatic disease;    chemotherapy;    Primary bone sarcomas;    Epidemiology;    malignant bone tumours;    Ewing sarcoma;    osteosarcomas;   

DOI  :  10.1302/2046-3758.115.BJR-2021-0258.R2

学科分类：骨科学

来源: British Editorial Society Of Bone And Joint Surgery

【 摘 要 】

AimsSocioeconomic and racial disparities have been recognized as impacting the care of patients with cancer, however there are a lack of data examining the impact of these disparities on patients with bone sarcoma. The purpose of this study was to examine socioeconomic and racial disparities that impact the oncological outcomes of patients with bone sarcoma.MethodsWe reviewed 4,739 patients diagnosed with primary bone sarcomas from the Surveillance, Epidemiology and End Results (SEER) registry between 2007 and 2015. We examined the impact of race and insurance status associated with the presence of metastatic disease at diagnosis, treatment outcome, and overall survival (OS).ResultsPatients with Medicaid (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.15 to 1.72) and uninsured patients (OR 1.90; 95% CI 1.26 to 2.86) had higher risks of metastatic disease at diagnosis compared to patients with health insurance. Compared to White patients, Black (OR 0.63, 95% CI 0.47 to 0.85) and Asian/Pacific Islander (OR 0.65, 95% CI 0.46 to 0.91) were less likely to undergo surgery. In addition, Black patients were less likely to receive chemotherapy (OR 0.67, 95% CI 0.49 to 0.91) compared to White patients. In patients with chondrosarcoma, those with Medicaid had worse OS compared to patients with insurance (hazard ratio (HR) 1.65, 95% CI 1.06 to 2.56).ConclusionIn patients with a bone sarcoma, the cancer stage at diagnosis varied based on insurance status, and racial disparities were identified in treatment. Further studies are needed to identify modifiable factors which can mitigate socioeconomic and racial disparities found in patients with bone sarcomas.

【 授权许可】

CC BY-NC