Disparities in Primary Spinal Osseous Malignant Bone Tumor Survival by Medicaid Status: A National Population-Based Risk Analysis

• Published in: World neurosurgery 2024-01, Vol.181, p.e192-e202
• Main Authors: Ganga, Arjun, Kim, Eric J., Lee, James Y., Leary, Owen P., Sastry, Rahul A., Fridley, Jared S., Chang, Ki-Eun, Niu, Tianyi, Sullivan, Patricia Zadnik, Somasundar, Ponnandai S., Gokaslan, Ziya L.
• Format: Article
• Language: English
• Subjects: Adult; Bone Neoplasms - pathology; Cancer disparities; Chondrosarcoma - surgery; Chordoma - surgery; Humans; Medicaid; Osteosarcoma - pathology; Risk Assessment; Sarcoma, Ewing - surgery; SEER Program; Socioeconomic factors; Spinal neoplasms; Spinal Neoplasms - pathology; Spine tumor; United States - epidemiology
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.09.103

The impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated. Using 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. A 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. Medicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.