Impact of Racial Disparities on All-Cause Mortality in Patients With Tumors of the Spinal Cord or Spinal Meninges: A Propensity-Score Analysis

Abstract

Study Design: Retrospective cohort study. Objective: The influence that race has on mortality rates in patients with spinal cord tumors is relatively unknown. The aim of this study was to investigate the influence of race on the outcomes of patients with primary malignant or nonmalignant tumors of the spinal cord or spinal meninges. Methods: The Surveillance, Epidemiology, and End Results (SEER) Registry was used to identify all patients with a code for primary malignant or nonmalignant tumor of the spinal cord (C72.0) or spinal meninges (C70.1) from 1973 through 2016. Racial groups (African-American/Black vs. White) were balanced using propensity-score (PS) matching using a non-parsimonious 1:1 nearest neighbor matching algorithm. Overall survival (OS) estimates were obtained using the Kaplan-Meier method and compared across non-PS-matched and PS-matched groups using log-rank tests. Associations of survival with clinical variables was assessed using doubly robust Cox proportional-hazards (CPH) regression analysis. Results: There were a total of 7,498 patients identified with 648 (6.8%) being African American. African-American patients with primary intradural spine tumors were more likely to die of all causes than were White patients in both the non-PS-matched [HR: 1.26, 95% CI: (1.04, 1.51), P = 0.01] and PS-matched cohorts [HR: 1.64, 95% CI: (1.28, 2.11), P < 0.0001]. On multivariate CPH regression analysis age at diagnosis [HR: 1.03, 95% CI: (1.02, 1.05), P < 0.0001], race [HR: 1.82, 95% CI: (1.22, 2.74), P = 0.004), and receipt of RT [HR: 2.62, 95% CI: (1.56, 4.37), P = 0.0002) were all significantly associated with all-cause mortality, when controlling for other demographic, tumor, and treatment variables. Conclusions: Our study provides population-based estimates of the prognosis for patients with primary malignant or nonmalignant tumors of the spinal cord or spinal meninges and suggests that race may impact all-cause mortality.

Racial Disparities in Surgical Management For Early‐Stage Laryngeal Squamous Cell Carcinoma and Recurrent Dysplasia

“…In particular, patients from racial or ethnic minority groups and patients with lower socioeconomic status were found to be more likely to have lower or inadequate health literacy 26 . As a result, these patients may delay or not seek medical care and struggle to understand the health information they are presented 26,27 . Moreover, Black patients are more likely to receive radiotherapy and less likely to be offered surgery as a treatment option for laryngeal cancer treatment 8,28 .…”

Socioeconomic and Racial/Ethnic Disparities in Perception of Health Status and Literacy in Spine Oncological Patients

“…26 In addition, in a retrospective Surveillance, Epidemiology, and End Results (SEER) registry study of 7,498 patients admitted with primary malignant or non-malignant spinal tumors between 1973 and 2016, Elsamadicy et al showed Black patients had significantly greater all-cause mortality than did White patients. 10 Moreover, in an NIS database study of 145,809 patients who were admitted to the hospital for management of metastatic spinal disease between 2004 and 2014, De la Garza Ramos et al showed that Hispanic and Black patients had higher rates of inpatient complications and prolonged LOS when compared to White patients. 9 Furthermore, in a retrospective NIS database study of 3,595 patients who underwent surgery for an intradural spinal cord tumor between 2016 and 2017, Elsamadicy et al showed that Black race was associated with a longer LOS and more frequent non-routine discharges when compared to White and Hispanic patients.…”

“…Similarly, in a retrospective NIS database study of 19,017 patients admitted to the hospital for resection of spinal column tumors between 1993 and 2002, Patil et al found Black race to be an independent predictor of perioperative complications 26 . In addition, in a retrospective Surveillance, Epidemiology, and End Results (SEER) registry study of 7,498 patients admitted with primary malignant or non-malignant spinal tumors between 1973 and 2016, Elsamadicy et al showed Black patients had significantly greater all-cause mortality than did White patients 10 . Moreover, in an NIS database study of 145,809 patients who were admitted to the hospital for management of metastatic spinal disease between 2004 and 2014, De la Garza Ramos et al showed that Hispanic and Black patients had higher rates of inpatient complications and prolonged LOS when compared to White patients 9 .…”

“…Further, in another secondary data analysis of adult patients with cancer, Cartwright et al demonstrated that patients with poor health literacy were at a higher risk of hospitalizations 28 . This may, in part, contribute to the higher rates of prolonged LOS, 9 all-cause mortality, 10 non-routine discharges, 11 and unplanned readmissions 12 observed among Black and Hispanic patients with either primary or metastatic spinal tumors, as our study showed these populations more frequently report difficulty understanding health material. Indeed, underlying racial differences in health literacy have previously been attributed to causing worse healthcare outcomes in Hispanic and Black patients with other diseases, such as diabetes 19 and asthma 20 .…”

“…While there have been significant efforts to mitigate health outcome discrepancies between racial, ethnic, and socioeconomic groups, disparities still remain prevalent in healthcare 1–8 . More specifically, in surgical and non-surgical spinal oncology, Black and Hispanic patients have been found to be at a higher risk of experiencing a prolonged length of hospital stay (LOS), 9 mortality, 10 non-routine discharge, 11 and unplanned readmission 12 . Such inferior outcomes have previously been noted to increase patient disability and dissatisfaction, as well as drive excessive healthcare costs 13,14 .…”