Socioeconomic and Health Care Coverage Disparities in Children,
Adolescents and Young Adults with Sarcoma
Abstract
Background: Socioeconomic and health care coverage disparities are
established as poor prognostic markers in adults with sarcoma, but few
studies examine these differences among pediatric, adolescent and young
adults (AYA). This study examines the association between socioeconomic
status (SES), insurance status, and disease presentation among children
and AYA patients with sarcoma. Methods: This is a retrospective cohort
study of patients aged 0-25 years with bone or soft tissue sarcoma from
the National Cancer Database. SES assignments were based on estimated
median income and education-level. Patient demographics and clinical
factors were compared by SES and insurance status. Multivariate logistic
regression models were fitted to determine adjusted odds ratios of SES
and insurance status on metastatic disease or tumor size ≥5cm at time of
presentation. Results: In a cohort of 9112 patients, 2932 (32.1%) had
low, 2084 (22.8%) middle, and 4096 (44.9%) high SES. For insurance
status, 5864 (64.3%) had private, 2737 (30.0%) public, and 511 (5.6%)
were uninsured. Compared to high SES, patients with low SES were more
likely to have metastatic disease (OR=1.16, p=0.03) and tumors ≥5cm
(OR=1.29, p<0.01). Compared to private insurance, public and
no insurance were associated with metastatic disease (OR=1.35,
p<0.01 and OR=1.32, p=0.02) and increased tumors ≥5cm
(OR=1.28, p<0.01 and OR=1.67, p<0.01). Conclusions:
SES disparities exist among children and AYA patients with sarcoma. Low
SES and public or no insurance are associated with advanced disease at
presentation. Further studies are needed to identify interventions to
improve earlier detection of sarcomas in at-risk children and young
adults.