Racial and Ethnic Disparities in Presentation and Disposition Outcomes Among U.S. Spinal Cord Tumor Patients: Insights from a Nationwide Cohort

Introduction: This study investigates how race and ethnicity influence the presentation and discharge outcomes of patients with spinal cord tumors in the United States. We hypothesize that racial and ethnic minorities are more likely to present in non-elective or emergency settings and that these presentations lead to poorer discharge outcomes.

Methods: We analyzed data from the National Inpatient Sample (NIS) for patients surgically treated for spinal cord tumors between 2016 and 2020. Logistic regression models assessed the relationship between race/ethnicity and presentation type (elective vs. non-elective and ED vs. non-ED), adjusting for patient comorbidities, hospital characteristics, and socioeconomic factors. Discharge outcomes were categorized as routine or non-routine.

Results: A total of 3,190 patients were included: 71.47% non-Hispanic White, 11.91% Hispanic, 11.29% non-Hispanic Black, and 5.33% Asian/Pacific Islander (PI). Non-Hispanic Black and Hispanic patients were significantly less likely to present electively compared to non-Hispanic Whites (aOR 0.60, 95% CI 0.47-0.77, P< 0.001 and aOR 0.73, 95% CI 0.57-0.93, P=0.011, respectively). Conversely, non-Hispanic Black, Hispanic, and Asian/PI patients were more likely to present through the ED (aOR 1.48, 95% CI 1.26-1.93; aOR 1.40, 95% CI 1.07-1.82; and aOR 2.14, 95% CI 1.49-3.07, respectively). Non-elective presentations were associated with a 121% increased likelihood of non-routine discharge (aOR 2.21, 95% CI 1.88-2.60, P< 0.001). Hispanic (aOR 1.98, 95% CI 1.35-2.90) and non-Hispanic Black (aOR 3.49, 95% CI 2.36-5.16) patients had significantly worse discharge outcomes when presenting non-electively.

Conclusion : Significant racial and ethnic disparities exist in the presentation and outcomes of spinal cord tumor patients. Non-Hispanic Black and Hispanic patients are more likely to present emergently, resulting in worse discharge outcomes. These findings highlight the need for improved healthcare access and early intervention to reduce disparities in care for minority populations.