County-level socioeconomic, race-ethnicity, household, and infrastructure vulnerability associations with bone cancer treatment and prognosis in the US

Importance: The impact of social determinants of health (SDoH) on primary bone cancer (PBC) treatment and clinical outcomes has seen little inquiry due to restrictive study designs of narrow histology scopes, limited SDoH-factors assessed, and lacking geographic-span of study populations. Objectives: To assess how varied SDoH impact the surveillance, survival, and treatment of adults with PBCs in the US by quantifying the associations of the summative and individual influences of SDoH-vulnerability with outcome disparities. Design, setting, participants: This retrospective cohort study on adult PBC patients between 1975 and 2017 from the Surveillance-Epidemiology-End Results Program (SEER) database. Data were analyzed from November 2022 to January 2024. Exposures: Overall social vulnerability and its subcomponents comprised of 15 SDoH-factors in 4 themes of socioeconomic status (poverty, unemployment, income, high school education), minority-language (minoritized race/ethnicity, English proficiency), household composition (disability status, family members <18 or 65 + years, single-parent status) and housing-transportation (multiunit-mobile dwelling, overcrowding, vehicle access, group quarters) status and their total composite. Main outcomes and measures: Regression trends were used for SDoH-vulnerability associations with follow-up/surveillance period, survival period, and treatment receipt across PBCs. Results: For 13,664 PBC patients, increasing total social vulnerability was associated with significant decreases in surveillance period for chondrosarcomas, chordomas, Ewing sarcoma, malignant giant cell tumors, NOS Malignant Neoplasms, NOS or other Sarcomas, and osteosarcomas, ranging from 20.62 % to 51.07 % in relative decreases. Survival period decreases were observed with chondrosarcomas (44.08 %) and chordomas (31.30 %) when overall social vulnerability increased. Decreased receipt of recommended surgery (lowest, NOS or other sarcomas: OR 0.86; 95 %CI 0.76–0.97) and radiation therapy (lowest, Ewing Sarcoma: OR 0.89; 95 %CI 0.81–0.98) for several histology types was also observed with increasing total social vulnerability. Socioeconomic status, followed closely by housing-transportation and minority-language status vulnerabilities largely comprised these overall detrimental trends. Conclusions: Overall social vulnerability showed significant decreases in care receipt and worsened prognosis for PBC patients while quantifiably characterizing which factors disproportionately associated with detrimental trends, informing providers which SDoH should be addressed to more effectively combat PBC disparities.