Sex, racial/ethnic and socioeconomic disparities in patients with metastatic bone disease

Abstract

Background: We have analyzed sex, race/ethnicity or socioeconomic disparities in the incidence of metastatic bone disease (MBD).

Methods: Patients with the diagnosis of MBD at presentation for five most common primary anatomical sites was extracted from Surveillance, Epidemiology, and End Results Census tract-level dataset. Mean incidence of MBD for different sex, racial/ethnic and socioeconomic groups were compared.

Results: The five most common anatomical sites with MBD at presentation include "lung: (n = 59 739), "prostate" (n = 19 732), "breast" (n = 16 244), "renal" (n = 7718) and "colon" (n = 3068). There was an increase in incidence of MBD among cancers originating from prostate (annual percentage change [APC] 4.94), renal (APC 2.55), and colon (APC 3.21) (p < 0.05 for all). Non-Hispanic Blacks had higher incidence of MBD for prostate and breast primary sites (p < 0.001). Non-Hispanic American Indian Alaskan Native had higher incidence of MBD for cancers originating from renal (p < 0.001) and colon (p = 0.049). A higher incidence of MBD was seen in lower socioeconomic status (SES) groups for the selected sites (p < 0.001).

Conclusions: These findings suggest that there are multiple sex-related, racial/ethnic and SES disparities in the incidence of MBD from the 5 most common primary sites. Higher incidence seen among lower SES suggests delay in diagnosis and limited access to screening modalities.

Keywords: bone; dispartiy; metastasis.

Figure 1:

Incidence over time: a) Prostate Ca with metastatic bone disease (MBD), b) Renal and Urothelial Ca with MBD, c) Colon Ca with MBD showing statistically significant increase over time (2010-2016), d) Male breast cancer with MBD showing statistically significant increase over time (2010-2016).

Figure 2:

Incidence of primary cancers with metastatic bone disease (MBD) over time stratified by sex.

1. Lung cancer with MBD: Statistically significant higher incidence among males as compared to females. t-test p<0.001

2. Breast cancer with MBD: Statistically significant higher incidence among females as compared to males. t-test p<0.001

3. Renal and urothelial cancer with MBD: Statistically significant increase in incidence among males as compared to females. t-test p<0.001

4. Colon cancer with MBD: Statistically significant increase in incidence among males as compared to females. t-test p<0.001

Figure 3:

Incidence of primary cancers with metastatic bone disease (MBD) over time stratified by race/ethnicity. NHW: Non-Hispanic White, NHB: Non-Hispanic Black, NHAIAN: Non-Hispanic American Indian Alaskan Native, NHAPI: Non-Hispanic Asian Pacific Islanders, Hispanics

1. Lung cancer with MBD: Statistically significant differences in incidence among patients of different racial ethnic backgrounds (NHW, NHB, NHAIAN, NHAPI, Hispanic). One way ANOVA p<0.001

2. Prostate cancer with MBD: Statistically significant differences in incidence among patients of different racial ethnic backgrounds (NHW, NHB (highest incidence), NHAIAN, NHAPI, Hispanic). One way ANOVA p<0.001

3. Breast cancer with MBD: Statistically significant differences in incidence among patients of different racial ethnic backgrounds (NHW, NHB (highest incidence), NHAIAN, NHAPI, Hispanic). One way ANOVA p<0.001

4. Renal and urothelial cancer with MBD: Statistically significant differences in incidence among patients of different racial ethnic backgrounds (NHW, NHB, NHAIAN (highest incidence), NHAPI, Hispanic). One way ANOVA p<0.001

5. Colon cancer with MBD: Statistically significant differences in incidence among patients of different racial ethnic backgrounds (NHW, NHB, NHAIAN, NHAPI, Hispanic). One way ANOVA p=0.049

Figure 4:

Incidence of primary cancers with metastatic bone disease (MBD) over time stratified by socioeconomic status (SES). Group 1 (Lowest) through Group 5 (Highest).

1. Lung cancer with MBD: Statistically significant differences in incidence among patients of different SES groups (higher incidence in lower SES and lower incidence in higher SES). One way ANOVA p<0.001

2. Prostate cancer with MBD: Statistically significant differences in incidence among patients of different SES groups (higher incidence in lower SES and lower incidence in higher SES). One way ANOVA p<0.001

3. Breast cancer with MBD: Statistically significant differences in incidence among patients of different SES groups (higher incidence in lower SES and lower incidence in higher SES). One way ANOVA p<0.001

4. Renal and urothelial cancer with MBD: Statistically significant differences in incidence different SES groups (higher incidence in lower SES and lower incidence in higher SES). One way ANOVA p<0.001

   1. Colon cancer with MBD: Statistically significant differences in incidence among patients of different SES groups (higher incidence in lower SES and lower incidence in higher SES). One way ANOVA p<0.001

Figure 5:

Incidence of primary cancer with metastatic bone disease over time stratified by sex and SES.

1. Lung cancer with MBD: Two-factor ANOVA revealed a significant effect of sex (p<0.001) and effect of SES (p<0.001) on incidence. There was a statistically significant interaction between effect of sex and effect of SES on incidence was also observed (F (4,60) =45, p<0.001).

2. Breast cancer with MBD: Two-factor ANOVA revealed a significant effect of sex (p<0.001) and effect of SES (p<0.001) on incidence. There was a statistically significant interaction between effect of sex and effect of SES on incidence was also observed (F (4,60) =10.9, p<0.001).

3. Renal and urothelial cancer with MBD: Two-factor ANOVA revealed a significant effect of sex (p<0.001) and effect of SES (p<0.001) on incidence.

4. Colon cancer with MBD: Two-factor ANOVA revealed a significant effect of sex (p<0.001) and effect of SES (p<0.001) on incidence. There was a statistically significant interaction between effect of sex and effect of SES on incidence was also observed (F (4,60) =4.9, p=0.002).

Figure 6:

Incidence of primary cancer with metastatic bone disease over time stratified by race and SES.

1. Lung cancer with MBD: Two-factor ANOVA revealed a significant effect of race (p<0.001) and effect of SES (p=0.031) on incidence. There was a statistically significant interaction between effect of race and effect of SES on incidence was also observed (F (16,125) =5.4, p<0.001).

2. Prostate cancer with MBD: Two-factor ANOVA revealed a significant effect of race (p<0.001) and effect of SES (p=0.027) on incidence.

3. Breast cancer with MBD: Two-factor ANOVA revealed a significant effect of race (p<0.001) on incidence. There was a statistically significant interaction between effect of race and effect of SES on incidence was also observed (F (16,125) =1.79, p=0.038).

4. Renal and urothelial cancer with MBD: Two-factor ANOVA revealed a significant effect of race (p<0.001) and effect of SES (p<0.001) on incidence. There was a statistically significant interaction between effect of race and effect of SES on incidence was also observed (F (16,125) =3.18, p<0.001).

5. Colon cancer with MBD: Two-factor ANOVA revealed a significant effect of SES (p<0.001) on incidence.