Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug;31(8):4882-4893.
doi: 10.1245/s10434-024-15299-5. Epub 2024 Jun 11.

Area Socioeconomic Status is Associated with Refusal of Recommended Surgery in Patients with Metastatic Bone and Joint Disease

Kyle Mani  1 , Emily Kleinbart  1 , Anne Schlumprecht  2 , Regina Golding  1 , Noel Akioyamen  3 , Hyun Song  1 , Rafael De La Garza Ramos  2 , Ananth Eleswarapu  3 , Rui Yang  3 , David Geller  3 , Bang Hoang  3 , Reza Yassari  2 , Mitchell S Fourman  4
Affiliations

Area Socioeconomic Status is Associated with Refusal of Recommended Surgery in Patients with Metastatic Bone and Joint Disease

Kyle Mani et al. Ann Surg Oncol. 2024 Aug.

Abstract

Background: This study sought to identify associations between the Yost Index, a geocoded area neighborhood socioeconomic status (nSES) score, and race/ethnicity with patient refusal of recommended surgery for metastatic bone disease.

Methods: Patients with metastatic bone disease were extracted from the Surveillance, Epidemiology, and End Results database. The Yost Index was geocoded using factor analysis and categorized into quintiles using census tract-level American Community Service (ACS) 5-year estimates and seven nSES measures. Multivariable logistic regression models calculated odds ratios (ORs) of refusal of recommended surgery and 95% confidence intervals (CIs), adjusting for clinical covariates.

Results: A total of 138,257 patients were included, of which 14,943 (10.8%) were recommended for surgical resection. Patients in the lowest nSES quintile had 57% higher odds of refusing surgical treatment than those in the highest quintile (aOR = 1.57, 95% CI 1.30-1.91, p < 0.001). Patients in the lowest nSES quintile also had a 31.2% higher age-adjusted incidence rate of not being recommended for surgery compared with those in the highest quintile (186.4 vs. 142.1 per 1 million, p < 0.001). Black patients had 34% higher odds of refusing treatment compared with White patients (aOR = 1.34, 95% CI 1.14-1.58, p = 0.003). Advanced age, unmarried status, and patients with aggressive cancer subtypes were associated with higher odds of refusing surgery (p < 0.001).

Conclusions: nSES and race/ethnicity are independent predictors of a patient refusing surgery for metastatic cancer to bone, even after adjusting for various clinical covariates. Effective strategies for addressing these inequalities and improving the access and quality of care of patients with a lower nSES and minority backgrounds are needed.

Keywords: Bone; Metastases; Race; Socioeconomic status; Surgery.

PubMed Disclaimer

Conflict of interest statement

Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All authors contributed substantially to this work. Neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Fig. 1
Fig. 1
STROBE flow diagram of the Inclusion/Exclusion criteria of the SEER study sample, 2010–2018, stratified by Yost Index Quintile
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Coleman RE, Roodman, Smith, Body, Suva, Vessella Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20):6243–6249. doi: 10.1158/1078-0432.CCR-06-0931. - DOI - PubMed
    1. Mollica MA, Smith AW, Tonorezos E, et al. Survivorship for individuals living with advanced and metastatic cancers: National Cancer Institute Meeting Report. JNCI J Natl Cancer Inst. 2022;114(4):489–495. doi: 10.1093/JNCI/DJAB223. - DOI - PMC - PubMed
    1. Diessner BJ, Weigel BJ, Murugan P, Zhang L, Poynter JN, Spector LG. Associations of socioeconomic status, public versus private insurance, and race/ethnicity with metastatic sarcoma at diagnosis. JAMA Netw Open. 2020;3(8):e2011087–e2011087. doi: 10.1001/JAMANETWORKOPEN.2020.11087. - DOI - PMC - PubMed
    1. Jawad MU, Pollock BH, Wise BL, et al. Sex, racial/ethnic and socioeconomic disparities in patients with metastatic bone disease. J Surg Oncol. 2022;125(4):766. doi: 10.1002/JSO.26765. - DOI - PMC - PubMed
    1. Jawad MU, Pollock BH, Wise BL, et al. Socioeconomic and insurance-related disparities in disease-specific survival among patients with metastatic bone disease. J Surg Oncol. 2023;127(1):159–173. doi: 10.1002/JSO.27097. - DOI - PubMed

LinkOut - more resources