Virginia Polytechnic Institute and State University, Blacksburg, Virginia.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Pediatr Blood Cancer. 2020 Dec;67(12):e28708. doi: 10.1002/pbc.28708. Epub 2020 Sep 17.
Socioeconomic and health care coverage disparities are established as poor prognostic markers in adults with sarcoma, but few studies examine these differences among pediatric, adolescents and young adults (AYA). This study examines the association between socioeconomic status (SES), insurance status, and disease presentation among children and AYA patients with sarcoma.
This is a retrospective cohort study of patients aged 0-25 years with bone or soft tissue sarcoma from the National Cancer Database. SES assignments were based on estimated median income and education level. Patient demographics and clinical factors were compared by SES and insurance status. Multivariate logistic regression models were fitted to determine adjusted odds ratios of SES and insurance status on metastatic disease or tumor size ≥5 cm at time of presentation.
In a cohort of 9112 patients, 2932 (32.1%) had low, 2084 (22.8%) middle, and 4096 (44.9%) high SES. For insurance status, 5864 (64.3%) had private, 2737 (30.0%) public, and 511 (5.6%) were uninsured. Compared to high SES, patients with low SES were more likely to have metastatic disease (OR = 1.16, P = .03) and tumors ≥5 cm (OR = 1.29, P < .01). Compared to private insurance, public and no insurance were associated with metastatic disease (OR = 1.35, P < .01 and OR = 1.32, P = .02) and increased tumors ≥5 cm (OR = 1.28, P < .01 and OR = 1.67, P < .01).
SES disparities exist among children and AYA patients with sarcoma. Low SES and public or no insurance are associated with advanced disease at presentation. Further studies are needed to identify interventions to improve earlier detection of sarcomas in at-risk children and young adults.
社会经济和医疗保健覆盖差距被确立为成人肉瘤患者的不良预后标志物，但很少有研究检查儿童和青少年及年轻成人（AYA）中的这些差异。本研究检查了社会经济地位（SES）、保险状况与肉瘤儿童和 AYA 患者疾病表现之间的关系。
这是一项对国家癌症数据库中年龄在 0-25 岁之间患有骨或软组织肉瘤的患者进行的回顾性队列研究。SES 分配基于估计的中位收入和教育水平。根据 SES 和保险状况比较患者人口统计学和临床因素。使用多变量逻辑回归模型确定 SES 和保险状况对转移性疾病或就诊时肿瘤大小≥5cm 的调整比值比。
在 9112 例患者队列中，2932 例（32.1%）SES 较低，2084 例（22.8%）SES 中等，4096 例（44.9%）SES 较高。在保险状况方面，5864 例（64.3%）有私人保险，2737 例（30.0%）有公共保险，511 例（5.6%）没有保险。与高 SES 相比，SES 较低的患者更有可能患有转移性疾病（OR=1.16，P=0.03）和肿瘤≥5cm（OR=1.29，P<0.01）。与私人保险相比，公共保险和无保险与转移性疾病相关（OR=1.35，P<0.01 和 OR=1.32，P=0.02）和肿瘤≥5cm 增加（OR=1.28，P<0.01 和 OR=1.67，P<0.01）。
肉瘤儿童和 AYA 患者中存在 SES 差距。SES 较低和公共或无保险与就诊时的晚期疾病有关。需要进一步研究以确定干预措施，以改善高危儿童和年轻成人中肉瘤的早期发现。
