Social determinants are associated with clinical presentation of acute pathological fracture in metastatic long-bone disease

Background

Social Determinants of Health (SDOH) are non-medical factors that influence health, which have gained recognition across medical disciplines. Their impact on survival and disease presentation of patients with metastatic bone disease (MBD) remains unexplored.

Methods

This retrospective observational study included 712 undergoing surgery for symptomatic long-bone metastases patients between 2013 and 2022. SDOH were evaluated using Cox Proportional hazards regression for post-operative survival. A multivariate logistic regression analysis was performed to identify associated factors for clinical presentation with a completed pathologic fracture.

Results

The median overall survival was 264 days (IQR 74–772). Clinical presentation with a pathologic fracture as the initial symptom of metastatic bone disease (MBD) was observed in 15 % of patients (106/712).

SDOH factors played a significant role in clinical presentation. Patients with secondary insurance coverage were substantially less likely to present with a pathologic fracture (OR 0.26, 95 % CI 0.14–0.49; p < 0.01). In a sub-analysis of the most common tumors (breast, renal, and lung cancer patients; n = 353), attending college was associated with a significantly lower likelihood of presenting with a pathologic fracture as the initial symptom of metastatic bone disease (OR 0.54, 95 % CI 0.30–0.95; p = 0.03)

Conclusion

This study suggests that unfavorable SDOH factors are associated with decreased post-operative survival and a higher likelihood of initial clinical presentation with a completed pathological fracture. Incorporating social determinants into comprehensive care strategies for individuals with MBD may guide targeted interventions and optimize patient management to improve outcomes.