O3246: Child Opportunity Index and the Presentation of Pediatric Orthopedic Malignancy: An Evaluation of How Neighborhood Circumstances Affect Osteosarcoma Presentation and Outcomes

Background: Literature surrounding health inequities and the complex interplay between environment, disease, and the individual is an area of active research throughout medicine. A tool to quantify different social determinants of health, The Child Opportunity Index (COI) blends 29 indicators of neighborhood conditions into a normalized score to represent the relative opportunity children living in these neighborhoods have. The aim of this study is to evaluate how a child’s environment as measured by COI relates to their presentation and treatment for osteosarcoma to better understand how a child’s circumstances influences their disease course and clarify the cumulative burden of these determinants on children who present with a potentially deadly disease.

Methods: Following IRB approval, medical records from a large, urban pediatric tertiary cancer center from the years 2010-2022 were queried for cases of osteosarcoma. Data regarding patient demographics, presentation, treatment course, complications, and post-operative rehabilitation course were collected from the electronic medical record. Nationally normed COI scores and quintiles were extracted and the upper two quintiles (HIGH) and lower two quintiles (LOW) were pooled for comparison. Univariate analysis using one-way ANOVA or independent t-test as appropriate and linear regression multivariate analysis were used to compare variables of interest between groups.

Results: There were 67 patients in the HIGH group (56.72% male) and 28 patients (57.14% male) in the LOW group. There was a significant difference in racial composition between groups with more black patients in the LOW group (46.42% versus 7.46%, p< 0.01) and more white patients in the HIGH group (79.10% versus 32.14%, p < 0.01). The LOW group was more likely to have public insurance while the HIGH group was more likely to have private insurance (p < 0.01).

Patients in the LOW group had a significantly longer time from symptom to presentation, an average 28.95 days longer, than patients in the HIGH group, after controlling for sex, race, and insurance status (p=0.03). There was also a significant longer time between first visit and initiation of chemotherapy for the LOW group, average 22.68 day difference, after controlling for sex, race, and insurance status (p = 0.04). There was also a significant difference with regard to Physical Therapy attendance between groups, after controlling for race, insurance status, and sex (p=0.024)

Conclusion: There are stark disparities in time to presentation of pediatric patients with osteosarcoma based on their neighborhood conditions indicating the need for further research and intervention development targeted to children living in lower opportunity environments.