Garcia Ambar, Tyler Wakenda
From the Vagelos College of Physicians of Surgeons, Columbia University, New York, NY (Garcia), and Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY (Tyler).
J Am Acad Orthop Surg. 2025 Mar 15;33(6):319-326. doi: 10.5435/JAAOS-D-24-00634. Epub 2024 Dec 27.
The odds of metastatic disease at diagnosis of bone (BS) and soft-tissue sarcomas (STS) of the extremities and pelvis may vary among patients due to several factors. There is limited research comparing the rates of metastatic disease at diagnosis in patients from different demographic and socioeconomic backgrounds.
Patients with a primary BS or STS of the extremity or pelvis were identified using International Classification of Diseases codes. Sex, ethnicity, race, insurance type, and preferred language were collected from the medical records. Cross-tabulations and odds ratios with 95% confidence intervals were calculated to compare the frequencies of metastatic disease at diagnosis in various subgroups. Univariate and multivariate analyses were conducted to evaluate the relationship between socioeconomic factors and metastatic status at diagnosis.
Of the 2,598 individuals identified by the International Classification of Diseases search, 711 met criteria for this study. Preferred language was not associated with the American Joint Committee on Cancer stage ( P value = 0.94). The odds of metastases at diagnosis were higher in patients who had Spanish as a primary language (odds ratio = 2.14 [1.20-3.72], P value = 0.007), no insurance ( P value = 0.002), and histology consistent with leiomyosarcoma ( P value = 0.003) or Ewing sarcoma ( P value = 0.0004). Patients who identified Spanish as a preferred language had lower odds of having employer insurance (odds ratio = 0.29 [0.16-0.49], P value = 0.0000007).
This study was conducted at a single academic medical center that serves a large Spanish-speaking patient population. The results highlight health disparities in patients diagnosed with primary BS and STS of the extremity and pelvis, including higher rates of metastatic disease at diagnosis among primary Spanish-speaking and uninsured patients. Further research is needed to assess the effect of primary language on outcomes in orthopaedic surgery. Additional research should compare how different methods of interpretation affect the quality of care in orthopaedic surgery.
由于多种因素，四肢和骨盆骨肉瘤（BS）及软组织肉瘤（STS）诊断时出现转移性疾病的几率在患者之间可能有所不同。比较不同人口统计学和社会经济背景患者诊断时转移性疾病发生率的研究有限。
使用国际疾病分类代码识别患有四肢或骨盆原发性BS或STS的患者。从医疗记录中收集性别、种族、民族、保险类型和首选语言。计算交叉表和95%置信区间的比值比，以比较各亚组诊断时转移性疾病的频率。进行单因素和多因素分析，以评估社会经济因素与诊断时转移状态之间的关系。
在国际疾病分类搜索识别出的2598名个体中，711名符合本研究标准。首选语言与美国癌症联合委员会分期无关（P值 = 0.94）。以西班牙语为主要语言的患者（比值比 = 2.14 [1.20 - 3.72]，P值 = 0.007）、没有保险的患者（P值 = 0.002）以及组织学与平滑肌肉瘤一致的患者（P值 = 0.003）或尤因肉瘤患者（P值 = 0.0004）诊断时发生转移的几率更高。将西班牙语作为首选语言的患者拥有雇主保险的几率较低（比值比 = 0.29 [0.16 - 0.49]，P值 = 0.0000007）。
本研究在一个为大量讲西班牙语患者群体服务的单一学术医疗中心进行。结果突出了被诊断患有四肢和骨盆原发性BS和STS患者的健康差异，包括以西班牙语为主要语言和未参保患者诊断时转移性疾病发生率较高。需要进一步研究以评估主要语言对骨科手术结局的影响。更多研究应比较不同口译方法如何影响骨科手术的护理质量。
