• World Neurosurg · Jan 2024

    Disparities in primary spinal osseous malignant bone tumor survival by Medicaid-status: a national population-based risk analysis.

    • Arjun Ganga, Eric J Kim, James Y Lee, Owen P Leary, Rahul A Sastry, Jared S Fridley, Ki-Eun Chang, Tianyi Niu, Patricia Zadnik Sullivan, Ponnandai S Somasundar, and Ziya L Gokaslan.
    • Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
    • World Neurosurg. 2024 Jan 1; 181: e192e202e192-e202.

    BackgroundThe impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated.MethodsUsing the SEER-Medicaid database, adults diagnosed between 2006 and 2013 with sPMBT including chordoma, osteosarcoma, chondrosarcoma, Ewing sarcoma, or malignant giant cell tumor (GCT) were studied. Five-year survival analysis was performed using the Kaplan-Meier method. Adjusted survival analysis was performed using Cox proportional-hazards regression controlling for age, sex, marital status, cancer stage, poverty level, vertebral versus sacral location, geography, rurality, tumor diameter, tumor grade, tumor histology, and therapy.ResultsA total of 572 patients with sPMBT (Medicaid: 59, non-Medicaid: 513) were identified. Medicaid patients were more likely to be younger (P < 0.001), Black (P < 0.001), live in high poverty neighborhoods (P = 0.006), have distant metastases at diagnosis (P < 0.001), and less likely to receive surgery (P = 0.006). The 5-year survival rate was 65.7% (chondrosarcoma: 70.0%, chordoma: 91.5%, Ewing sarcoma: 44.6%, GCT: 90.0%, osteosarcoma: 34.2%). Medicaid patients had significantly worse 5-year survival than non-Medicaid patients (52.0% vs. 67.2%, P = 0.02). Minority individuals on Medicaid were associated with an increased risk of cancer-specific mortality compared with White non-Medicaid patients (adjusted hazard ratio [aHR] = 2.51, [95% CI 1.18-5.35], P = 0.017). Among Medicaid patients, those who received surgery had significantly better survival than those who did not (64.5% vs. 30.6%, P = 0.001). For all patients, not receiving surgery (aHR = 1.90 [1.23-2.95], P = 0.004) and tumor diameter >50 mm (aHR=1.89 [1.10-3.25], P = 0.023) were associated with an increased risk of mortality.ConclusionsMedicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.Copyright © 2023. Published by Elsevier Inc.

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