Investigating Age, Gender, and Urbanicity Disparities in Malignant Spinal Tumor Mortality Rates

Introduction: Malignant spinal tumors are rare and account for about 20% of primary spinal tumors. While previous studies have investigated racial disparities in all-cause mortality for these tumors, examining location-specific mortality trends by urbanization level can better identify geographic risk factors, access to care issues, and health disparities. This study evaluated malignant spinal tumor mortality rates and disparities between cities grouped by urbanization size to inform tailored prevention and treatment strategies.

Methods: Mortality data for malignant spinal tumors (ICD-10 code: C72.0) from 2000-2020 were obtained from the CDC WONDER database. Cities were categorized into 5 urbanization levels based on population size. Age-adjusted mortality rates per 100,000 and 95% confidence intervals were calculated for each urbanization level. Disparities were assessed using rate ratios and rate differences. ANOVA and pairwise comparisons were performed in R to evaluate differences in mortality rates between urbanization levels (α=0.05).

Results: Our analysis of crude death rates among patients with malignant spinal tumors revealed significant age and gender disparities. Death rates increased markedly with age, from 2.5-4.3% in the 45-54 age group to 21.4-33.6% in the 85+ age group (p=0.027), with the steepest rise after age 65. This finding underscores the importance of considering age-specific factors in the management of malignant spinal tumors. Males had consistently higher death rates than females across all urbanicity levels (male: 3.7-5.2%, female: 3.2-4.1%; p< 0.001), suggesting potential biological differences or disparities in access to care. Urbanicity did not significantly impact death rates overall (p=0.406), but potential interactions between age, gender, and urbanicity were observed in subgroup analysis.

Conclusion : Age and gender significantly influence mortality in malignant spinal tumor patients, while urbanicity's impact is more complex. These findings highlight the need for age- and gender-specific treatment strategies and close monitoring of high-risk patients to improve outcomes.