Racial disparities in clinical presentation, type of intervention, and in-hospital outcomes of patients with metastatic spine disease: An analysis of 145,809 admissions in the United States.
Black or African American
/ statistics & numerical data
Aged
Asian People
/ statistics & numerical data
Ethnicity
/ statistics & numerical data
Female
Healthcare Disparities
Hispanic or Latino
/ statistics & numerical data
Hospitalization
/ statistics & numerical data
Humans
Income
Male
Middle Aged
Retrospective Studies
Spinal Cord Compression
/ diagnosis
Spinal Neoplasms
/ diagnosis
United States
White People
/ statistics & numerical data
Complications
Disparity
Ethnicity
Race
Socioeconomic
Spinal metastasis
Journal
Cancer epidemiology
ISSN: 1877-783X
Titre abrégé: Cancer Epidemiol
Pays: Netherlands
ID NLM: 101508793
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
22
04
2020
revised:
10
07
2020
accepted:
26
07
2020
pubmed:
12
8
2020
medline:
26
1
2021
entrez:
12
8
2020
Statut:
ppublish
Résumé
Race is an important determinant of cancer outcome. The purpose of this study was to identify disparities in clinical presentation, treatment use, and in-hospital outcomes of patients with spinal metastases. The United States National Inpatient Sample database (2004-2014) was queried to identify patients with metastatic disease and cord compression (MSCC) or spinal pathological fracture. Clinical presentation, type of intervention, and in-hospital outcomes were compared between races/ethnicities. Multivariate logistic regression analyses were performed and adjusted for differences in patient age, sex, insurance status, income quartile, hospital teaching status and size, Charlson comorbidity index, smoking status, tumor type, and neurological status. A total of 145,809 patients were identified - 74.8 % Caucasian, 14.1 % African-American, 7.9 % Hispanic, and 3.2 % Asian. Over one-third of patients (38.1 %) presented with MSCC; 35.7 % of Caucasians, 50.3 % of AAs, 41.1 % of Hispanics, and 39.8 % of Asians (p < 0.001). Paralysis affected 8.4 % of all patients; 7.4 % of Caucasians, 12.7 % of AAs, 10.5 % of Hispanics, and 10.0 % of Asians (p < 0.001). For patients with MSCC, multivariate analysis showed that AAs were less likely to undergo surgical intervention (OR 0.71; 95 % CI, 0.62 - 0.82; p < 0.001), significantly more likely to experience a complication (OR 1.25; 95 % CI, 1.12-1.40; p < 0.001), significantly more likely to experience prolonged length of stay (OR 1.22; 95 % CI, 1.08-1.36; p = 0.001), and significantly more likely to experience a non-routine discharge (OR 1.19; 95 % CI, 1.05-1.35; p = 0.007) compared to Caucasians. Minority groups with spinal metastatic disease may be at a disadvantage compared to Caucasians, with significant disparities found in presenting characteristics, type of intervention, and in-hospital outcomes. Continued efforts to overcome these differences are needed.
Sections du résumé
BACKGROUND
Race is an important determinant of cancer outcome. The purpose of this study was to identify disparities in clinical presentation, treatment use, and in-hospital outcomes of patients with spinal metastases.
METHODS
The United States National Inpatient Sample database (2004-2014) was queried to identify patients with metastatic disease and cord compression (MSCC) or spinal pathological fracture. Clinical presentation, type of intervention, and in-hospital outcomes were compared between races/ethnicities. Multivariate logistic regression analyses were performed and adjusted for differences in patient age, sex, insurance status, income quartile, hospital teaching status and size, Charlson comorbidity index, smoking status, tumor type, and neurological status.
RESULTS
A total of 145,809 patients were identified - 74.8 % Caucasian, 14.1 % African-American, 7.9 % Hispanic, and 3.2 % Asian. Over one-third of patients (38.1 %) presented with MSCC; 35.7 % of Caucasians, 50.3 % of AAs, 41.1 % of Hispanics, and 39.8 % of Asians (p < 0.001). Paralysis affected 8.4 % of all patients; 7.4 % of Caucasians, 12.7 % of AAs, 10.5 % of Hispanics, and 10.0 % of Asians (p < 0.001). For patients with MSCC, multivariate analysis showed that AAs were less likely to undergo surgical intervention (OR 0.71; 95 % CI, 0.62 - 0.82; p < 0.001), significantly more likely to experience a complication (OR 1.25; 95 % CI, 1.12-1.40; p < 0.001), significantly more likely to experience prolonged length of stay (OR 1.22; 95 % CI, 1.08-1.36; p = 0.001), and significantly more likely to experience a non-routine discharge (OR 1.19; 95 % CI, 1.05-1.35; p = 0.007) compared to Caucasians.
CONCLUSION
Minority groups with spinal metastatic disease may be at a disadvantage compared to Caucasians, with significant disparities found in presenting characteristics, type of intervention, and in-hospital outcomes. Continued efforts to overcome these differences are needed.
Identifiants
pubmed: 32781406
pii: S1877-7821(20)30126-0
doi: 10.1016/j.canep.2020.101792
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
101792Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.