Socioeconomic and insurance-related disparities in disease-specific survival among patients with metastatic bone disease

Background Approximately 5% of cancer patients in the United States presented with metastatic bone disease (MBD) at diagnosis. Current study explores the disparities in survival for patients with MBD. Methods Patients with the diagnosis of MBD at presentation for the five most common primary anatomical sites were extracted from Surveillance, Epidemiology, and End Results Census tract-level dataset (2010-2016). Kaplan-Meier and Cox Proportional Hazard models were used to evaluate survival, and prognostic factors for each cohort. Prognostic significance of socioeconomic status (SES) and insurance status were ascertained. Results The five most common anatomical-sites with MBD at presentation included lung (n = 59 739), prostate (n = 19 732), breast (n = 16 244), renal and urothelium (n = 7718) and colon (n= 3068). Lower SES was an independent risk factor for worse disease-specific survival (DSS) for patients with MBD originating from lung, prostate, breast and colon. Lack of insurance was an independent risk factor for worse DSS for MBD patients with primary tumors in lung and breast. Conclusions MBD patients from the five most common primary sites demonstrated SES and insurance-related disparities in disease-specific survival. This is the first and largest study to explore SES and insurance-related disparities among patients specifically afflicted with MBD. Our findings highlight vulnerability of patients with MBD across multiple primary sites to financial toxicity.

Automated summary

This study explores the impact of socioeconomic status and insurance status on survival disparities among patients with metastatic bone disease. The results demonstrate that lower socioeconomic status and lack of insurance are associated with worse disease-specific survival in patients with primary tumors in the lung, prostate, breast, and colon.