O2112: Socioeconomic Status Impacts the Rate of Evaluation for Pediatric Hand and Wrist Tumors

Background: Socioeconomic status is known to impact the presentation and treatment of various orthopaedic conditions. However, the relationship between the socioeconomic status of the patient and pediatric hand tumors is currently not well studied. Using two different socioeconomic indices—the Child Opportunity Index (COI) and Area Deprivation Index (ADI) — this study aims to evaluate the impact of socioeconomic status on presentation and treatment of hand and wrist tumors and tumor-like lesions in pediatric patients.

Methods: We identified patients ≤ 18 years of age with a hand or wrist tumor or tumor-like lesion at a single tertiary-care children’s hospital between 2008-2022. Patients with underlying genetic conditions such as multiple hereditary exostoses and Ollier disease were excluded. Additionally, patients with commonly encountered masses including lipomas, ganglion and sebaceous cysts were excluded. Patients in the middle quintile (40th-60th percentile) of COI were also excluded to allow comparison of the lowest and highest COI quintiles. Demographic information, insurance status, socioeconomic indices, presentation, and treatment were recorded. We performed descriptive statistics and multivariate regression analyses.

Results: 269 patients with tumors and tumor-like lesions in the hand or wrist were included (Table 1). 136 patients had bone lesions, while 133 patients had soft tissue lesions. There were 257 benign and 12 malignant lesions. Osteochondromas (n=61) and enchondromas (n=41) were the most common bone lesions, while vascular malformations (n=30) and giant cell tumors of the tendon sheath (n=24) were the most common soft tissue lesions. A disproportionate number of patients in the High/Very High COI quintiles sought evaluation compared to the compared to Low/Very Low quintiles (189, 80; p = 0.035). Not surprisingly, there were significant associations between COI and ADI (p < 0.001), insurance status (p < 0.001), and race (p < 0.001). Interestingly, there were no significant differences between high vs. low COI quintiles or private vs. public insurance with regards to time to presentation (time elapsed between the initial onset of symptoms and first visit), rate of surgical treatment, time to surgery, and tumor recurrence. However, children with Low/Very Low COI had significantly higher loss to follow-up rates (16% vs. 30%; p< 0.010). Neither COI nor ADI was a significant predictor of time to presentation or surgical treatment using linear and logistic regression models respectively and controlling for race, insurance, and age.

Conclusion: There was a smaller proportion of patients in the two lowest COI quintiles which indicates that socioeconomic status significantly impacts whether a child with a hand/wrist tumor is brought in for evaluation. Additionally, Children in lower COI quintiles were twice as likely to be lost to follow-up which needs to be considered when planning tumor surveillance. However, the treatment of the patients saw no significant differences between time to presentation and rate of surgical treatment regardless of COI.