Do Race, Insurance Status, and Income Factors Impact Pathologic Fracture Presentation and Management?

Area of Science:

• Oncology
• Orthopedic Surgery
• Health Services Research

Background:

• Metastatic bone disease (MBD) and pathologic fractures (PF) significantly impact patient quality of life, functionality, and survival.
• Understanding management and access to care for PF is crucial for improving patient outcomes and survival.
• This study investigates disparities in MBD care within the U.S. healthcare system.

Purpose of the Study:

• To determine if race, income, and insurance status influence prophylactic stabilization versus acute fixation of PF.
• To assess the association of race, income, and insurance status with complications in MBD patients.
• To examine the relationship between race, income, insurance, length of stay, and insurance type in MBD patients.

Main Methods:

• Utilized the NIS HCUP database from 2016-2020, identifying patients with pathological fractures and associated cancer diagnoses.
• Employed General Linear Models (GLMs) to analyze differences in fracture management, complications, and healthcare utilization.
• Conducted post hoc analyses for specific metastatic causes to further explore disparities.

Main Results:

• No significant differences were found in race, income, or insurance status regarding impending versus acute fractures.
• Black patients were more likely to experience complications, while Hispanic patients were least likely.
• Black patients incurred higher hospital costs, and both Black and Hispanic patients had longer hospitalizations, often with Medicaid or no insurance.

Conclusions:

• Healthcare disparities were identified in patients with impending and overt PF due to MBD.
• These disparities exist despite minimal differences in patient comorbidities, fracture management, or hospitalization complications.
• Addressing these disparities is essential for equitable MBD patient care and improved outcomes.