Racial disparities in clinical presentation, type of intervention, and in-hospital outcomes of patients with metastatic spine disease: An analysis of 145,809 admissions in the United States Journal Article

  

Authors:	De la Garza Ramos, R.; Benton, J. A.; Gelfand, Y.; Echt, M.; Flores Rodriguez, J. V.; Yanamadala, V.; Yassari, R.
Article Title:	Racial disparities in clinical presentation, type of intervention, and in-hospital outcomes of patients with metastatic spine disease: An analysis of 145,809 admissions in the United States
Abstract:	Background: Race is an important determinant of cancer outcome. The purpose of this study was to identify disparities in clinical presentation, treatment use, and in-hospital outcomes of patients with spinal metastases. Methods: The United States National Inpatient Sample database (2004–2014) was queried to identify patients with metastatic disease and cord compression (MSCC) or spinal pathological fracture. Clinical presentation, type of intervention, and in-hospital outcomes were compared between races/ethnicities. Multivariate logistic regression analyses were performed and adjusted for differences in patient age, sex, insurance status, income quartile, hospital teaching status and size, Charlson comorbidity index, smoking status, tumor type, and neurological status. Results: A total of 145,809 patients were identified – 74.8 % Caucasian, 14.1 % African-American, 7.9 % Hispanic, and 3.2 % Asian. Over one-third of patients (38.1 %) presented with MSCC; 35.7 % of Caucasians, 50.3 % of AAs, 41.1 % of Hispanics, and 39.8 % of Asians (p < 0.001). Paralysis affected 8.4 % of all patients; 7.4 % of Caucasians, 12.7 % of AAs, 10.5 % of Hispanics, and 10.0 % of Asians (p < 0.001). For patients with MSCC, multivariate analysis showed that AAs were less likely to undergo surgical intervention (OR 0.71; 95 % CI, 0.62 – 0.82; p < 0.001), significantly more likely to experience a complication (OR 1.25; 95 % CI, 1.12–1.40; p < 0.001), significantly more likely to experience prolonged length of stay (OR 1.22; 95 % CI, 1.08–1.36; p = 0.001), and significantly more likely to experience a non-routine discharge (OR 1.19; 95 % CI, 1.05–1.35; p = 0.007) compared to Caucasians. Conclusion: Minority groups with spinal metastatic disease may be at a disadvantage compared to Caucasians, with significant disparities found in presenting characteristics, type of intervention, and in-hospital outcomes. Continued efforts to overcome these differences are needed. © 2020 Elsevier Ltd
Keywords:	adult; cancer chemotherapy; aged; middle aged; cancer surgery; major clinical study; clinical feature; united states; cancer radiotherapy; antineoplastic agent; heart disease; kidney disease; cohort analysis; retrospective study; age; pneumonia; health insurance; length of stay; spinal cord compression; urinary tract infection; sepsis; complications; hospital admission; hospital discharge; sex difference; ethnic difference; neurological complication; race difference; gastrointestinal disease; ethnicity; african american; spine metastasis; caucasian; race; paralysis; hispanic; venous thromboembolism; spine surgery; disparity; spinal metastasis; asian; clinical outcome; bone biopsy; teaching hospital; pathologic fracture; spine fracture; socioeconomic; charlson comorbidity index; human; male; female; priority journal; article; decubitus; household income; people by smoking status
Journal Title:	Cancer Epidemiology
Volume:	68
ISSN:	1877-7821
Publisher:	Elsevier Inc.
Date Published:	2020-10-01
Start Page:	101792
Language:	English
DOI:	10.1016/j.canep.2020.101792
PUBMED:	32781406
PROVIDER:	scopus
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85089134942&doi=10.1016%2fj.canep.2020.101792&partnerID=40&md5=a9c4acad5e07e3d018352de5f015bab1
Notes:	Article -- Export Date: 1 September 2020 -- Source: Scopus

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