Demographic, Racial, and Geographic Disparities in Mortality and Place of Death Among Patients With Bone and Cartilage Tumors: A National Population-Based Study

Document Type

Conference Proceeding

Publication Date

12-2025

Publication Title

ESMO Rare Cancers

Abstract

Objective: Bone and cartilage tumors are rare, aggressive, and show variable outcomes, but national data on sociodemographic mortality disparities are limited. Methods: We utilized the CDC WONDER database to analyze mortality data for bone and cartilage tumors in the United States from 1999 to 2020 using C40 and C41 International Classification of Diseases 10 classification. We assessed mortality trends by race, ethnicity, age, sex, region and PoD. Odds ratios (OR) with 95% confidence intervals (CI) and p-values were computed using logistic regression to evaluate the association of these factors with PoD specially hospice utilization. Results: Among 31,990 deaths from bone and cartilage tumors, most were White (82%), followed by Black (10.6%), Asian/Pacific Islander (A/PI) (5%), and American Indian/Alaska Native (1.6%). The overall Age-Adjusted Mortality Rate (AAMR) was 0.45 per 100,000, lowest in A/PI (0.26) while highest in Whites and Blacks (0.46). Hispanic individuals had a lower AAMR (0.40) compared to non-Hispanics (0.46). AAMR was higher in rural areas (0.56) compared to urban areas (0.43) with highest being in Mississippi (1.08). Crude Mortality Rates (CMR) increased from 0.47 in individuals aged 15—24 to 3.43 per 100,000 in those aged 85 and older. The most common PoD were home (44.6%) followed by inpatient medical facilities (27.0%). Hospice utilization accounted for 7.1% of all deaths. Blacks had significantly higher odds of dying in inpatient, ER/outpatient settings, and being dead on arrival compared to Whites (Table). In contrast, blacks were significantly less likely to die at home. Younger individuals (< 65 years) had lower odds of dying in outpatient/ER settings (OR = 0.71), being dead on arrival (OR = 0.33), and in hospice facilities (OR = 0.87). (All p respectively < 0.01). Hospice utilization was highest in the South (7.9%), with maximum state wise-utilization in Delaware (24.6%) and Florida (22.6%). In contrast, California and Minnesota had the lowest hospice utilization. Conclusion: Black individuals were more likely to die in acute care settings and less likely at home compared to White individuals. Hospice utilization remained low overall, with notable variation by region and state. These findings highlight the need for targeted interventions to address disparities in EOL care and improve hospice access for patients with bone or cartilage tumors.

Volume

4

First Page

100085

Comments

Connective Tissue Oncology Society (CTSO) 2025 Annual Meeting, November 12-15, 2025, Boca Raton, FL

Last Page

100085

DOI

10.1016/j.esmorc.2025.100085

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