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Individual and Community-Level Social Determinant Associations with Skull Base Chordoma and Chondrosarcoma
David J Fei-Zhang1, Rishabh Sethia2,3, Atharva Desai4
1Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
Objective:
Using multivariate models of social determinants of health (SDoH) featuring census-level Yost Index-socioeconomic status (SES) measures, to determine whether community-level SDoH factors quantifiably influence skull base chordoma-chondrosarcoma disparities more than individual-level SDoH factors on care-prognostic differences nationally.
Design Setting Participants:
Retrospective cohort, skull base chordomas/chondrosarcoma patients diagnosed between 2010 and 2018 from SEER (Surveillance, Epidemiology, and End Results) were analyzed by multivariate, age-adjusted regressions and Cox proportional hazards models; covariates of sex, race-ethnicity, census-level rurality-urbanicity, census-level Yost-Index score (aggregating 7 SES-measures of education, income, housing).
Main Outcome Measures:
Mortality, late-staging, first-line/nonfirst-line treatment, delay-in-treatment.
Results:
Across 1,530 skull base chordomas and chondrosarcomas, delay-of-treatment featured a markedly positive independent predictor of minority race/ethnicity (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.27-1.34; p < 0.001). Five-year all-cause mortality showed markedly positive predictors of male-sex (1.82; 1.30-2.56; p < 0.001), minority race/ethnicity (OR, 1.94; 95% CI, 1.32-2.87; p = 0.001), and decreasing Yost-SES (OR, 1.61; 95% CI, 1.14-2.26; p = 0.006). Three-year all-cause mortality featured markedly positive predictors of male-sex (OR, 1.82; 95% CI, 1.30-2.56; p < 0.001) and minority race/ethnicity (OR, 1.75; 95% CI, 1.18-2.58; p = 0.005). Receipt of nonfirst-line radiation therapy showed a markedly positive independent predictor of minority race/ethnicity (OR, 1.34; 95% CI, 1.06-1.71; p = 0.016). Receipt of first-line primary surgery showed a markedly negative independent predictor of decreasing Yost-SES (OR, 0.71; 95% CI, 0.53-0.96; p = 0.024). Advanced-staging showed a markedly positive independent predictor of decreasing Yost-SES (OR, 1.85; 95% CI, 1.19-2.89; p = 0.006).
Conclusion:
Through interactional models of individual- and community-level social determinant factors, this study observed detrimental, interrelated SDoH associations with poorer care and prognosis of chordoma and chondrosarcoma patients while quantifiably delineating the strength of factor association with observed disparities.
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