Odds of Metastatic Disease at Diagnosis of Primary Bone and Soft-Tissue Sarcomas of the Extremity and Pelvis Based on Preferred Language and Socioeconomic Factors

Abstract

Introduction: The odds of metastatic disease at diagnosis of bone (BS) and soft-tissue sarcomas (STS) of the extremities and pelvis may vary among patients due to several factors. There is limited research comparing the rates of metastatic disease at diagnosis in patients from different demographic and socioeconomic backgrounds.

Methods: Patients with a primary BS or STS of the extremity or pelvis were identified using International Classification of Diseases codes. Sex, ethnicity, race, insurance type, and preferred language were collected from the medical records. Cross-tabulations and odds ratios with 95% confidence intervals were calculated to compare the frequencies of metastatic disease at diagnosis in various subgroups. Univariate and multivariate analyses were conducted to evaluate the relationship between socioeconomic factors and metastatic status at diagnosis.

Results: Of the 2,598 individuals identified by the International Classification of Diseases search, 711 met criteria for this study. Preferred language was not associated with the American Joint Committee on Cancer stage (P value = 0.94). The odds of metastases at diagnosis were higher in patients who had Spanish as a primary language (odds ratio = 2.14 [1.20-3.72], P value = 0.007), no insurance (P value = 0.002), and histology consistent with leiomyosarcoma (P value = 0.003) or Ewing sarcoma (P value = 0.0004). Patients who identified Spanish as a preferred language had lower odds of having employer insurance (odds ratio = 0.29 [0.16-0.49], P value = 0.0000007).

Conclusions: This study was conducted at a single academic medical center that serves a large Spanish-speaking patient population. The results highlight health disparities in patients diagnosed with primary BS and STS of the extremity and pelvis, including higher rates of metastatic disease at diagnosis among primary Spanish-speaking and uninsured patients. Further research is needed to assess the effect of primary language on outcomes in orthopaedic surgery. Additional research should compare how different methods of interpretation affect the quality of care in orthopaedic surgery.