Abstract：
OBJECTIVE: Socioeconomic 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.
METHODS: We 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).
RESULTS: Patients 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).
CONCLUSIONS: In 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. Cite this article: Bone Joint Res 2022;11(5):278-291.
METHODS: We 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).
RESULTS: Patients 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).
CONCLUSIONS: In 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. Cite this article: Bone Joint Res 2022;11(5):278-291.
摘要：
目的：社会经济和种族差异已被公认为影响癌症患者的护理，然而,目前缺乏研究这些差异对骨肉瘤患者的影响的数据.这项研究的目的是检查影响骨肉瘤患者肿瘤预后的社会经济和种族差异。
方法：我们回顾了从监测中诊断为原发性骨肉瘤的4,739例患者，2007年至2015年的流行病学和最终结果(SEER)登记。我们检查了诊断时与转移性疾病相关的种族和保险状况的影响，治疗结果,总生存率（OS）。
结果：医疗补助患者（比值比（OR）1.41;95％置信区间（CI）1.15至1.72）和未投保的患者（OR1.90;95％CI1.26至2.86）在诊断时具有更高的转移性疾病风险。与白人患者相比，黑人（OR0.63，95％CI0.47至0.85）和亚洲/太平洋岛民（OR0.65，95％CI0.46至0.91）不太可能接受手术。此外,与白人患者相比，黑人患者接受化疗的可能性较小（OR0.67，95％CI0.49至0.91）。在软骨肉瘤患者中，与有保险的患者相比,那些有Medicaid的患者的OS更差(风险比(HR)1.65,95%CI1.06~2.56).
结论：在骨肉瘤患者中，诊断时的癌症阶段因保险状况而异，在治疗中发现种族差异。需要进一步的研究来确定可改变的因素，这些因素可以减轻骨肉瘤患者的社会经济和种族差异。引用这篇文章：骨关节Res2022；11（5）：278-291。
方法：我们回顾了从监测中诊断为原发性骨肉瘤的4,739例患者，2007年至2015年的流行病学和最终结果(SEER)登记。我们检查了诊断时与转移性疾病相关的种族和保险状况的影响，治疗结果,总生存率（OS）。
结果：医疗补助患者（比值比（OR）1.41;95％置信区间（CI）1.15至1.72）和未投保的患者（OR1.90;95％CI1.26至2.86）在诊断时具有更高的转移性疾病风险。与白人患者相比，黑人（OR0.63，95％CI0.47至0.85）和亚洲/太平洋岛民（OR0.65，95％CI0.46至0.91）不太可能接受手术。此外,与白人患者相比，黑人患者接受化疗的可能性较小（OR0.67，95％CI0.49至0.91）。在软骨肉瘤患者中，与有保险的患者相比,那些有Medicaid的患者的OS更差(风险比(HR)1.65,95%CI1.06~2.56).
结论：在骨肉瘤患者中，诊断时的癌症阶段因保险状况而异，在治疗中发现种族差异。需要进一步的研究来确定可改变的因素，这些因素可以减轻骨肉瘤患者的社会经济和种族差异。引用这篇文章：骨关节Res2022；11（5）：278-291。
