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Socioeconomic and Health Care Coverage Disparities in Children, Adolescents and Young Adults with Sarcoma
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  • Carly Westermann,
  • Jennine Weller,
  • Felipe Pedroso,
  • Joe Canner,
  • Christine Pratilas,
  • Daniel Rhee
Carly Westermann
Virginia Polytechnic Institute and State University
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Jennine Weller
Johns Hopkins School of Medicine
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Felipe Pedroso
Johns Hopkins School of Medicine
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Joe Canner
Johns Hopkins School of Medicine
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Christine Pratilas
Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center
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Daniel Rhee
Johns Hopkins School of Medicine
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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.

Peer review status:Published

30 May 2020Submitted to Pediatric Blood & Cancer
30 May 2020Submission Checks Completed
30 May 2020Assigned to Editor
03 Jun 2020Reviewer(s) Assigned
24 Jun 2020Review(s) Completed, Editorial Evaluation Pending
24 Jun 2020Editorial Decision: Revise Major
31 Aug 20201st Revision Received
31 Aug 2020Submission Checks Completed
31 Aug 2020Assigned to Editor
01 Sep 2020Review(s) Completed, Editorial Evaluation Pending
01 Sep 2020Editorial Decision: Accept
Dec 2020Published in Pediatric Blood & Cancer volume 67 issue 12. 10.1002/pbc.28708