title: Low income and rural county of residence increase mortality from bone and joint sarcomas.
abstract: BACKGROUND
  This is a part of a larger effort to characterize the effects on socio-economic factors (SEFs) on cancer outcome. Surveillance, Epidemiology and End Result (SEER) bone and joint sarcoma (BJS) data were used to identify potential disparities in cause specific survival (CSS).
  
  
  METHODS
  This study analyzed SEFs in conjunction with biologic and treatment factors. Absolute BJS specific risks were calculated and the areas under the receiver operating characteristic (ROC) curve were computed for predictors. Actuarial survival analysis was performed with Kaplan-Meier method. Kolmogorov-Smirnov's 2-sample test was used to for comparing two survival curves. Cox proportional hazard model was used for multivariate analysis.
  
  
  RESULTS
  There were 13501 patients diagnosed BJS from 1973 to 2009. The mean follow up time (SD) was 75.6 (90.1) months. Staging was the highest predictive factor of outcome (ROC area of 0.68). SEER stage, histology, primary site and sex were highly significant pre-treatment predictors of CSS. Under multivariate analysis, patients living in low income neighborhoods and rural areas had a 2% and 5% disadvantage in cause specific survival respectively.
  
  
  CONCLUSIONS
  This study has found 2-5% decrement of CSS of BJS due to SEFs. These data may be used to generate testable hypothesis for future clinical trials to eliminate BJS outcome disparities.
authors.affiliation: 275 South Bryn Mawr Ave, Bryn Mawr, PA E-mail : cheung.r100@gmail.com.
authors.forename: Min Rex
authors.initials: MR
authors.lastname: Cheung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007592:Joint Diseases / Q000401:mortality* / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011203:Poverty / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012424:Rural Population / Q000706:statistics & numerical data*; D018426:SEER Program; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology; D012737:Sex Factors; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D014481:United States / Q000453:epidemiology; D055815:Young Adult