Beyond Science: Effect of Marital Status and Socioeconomic Index on Outcomes of Spinal Cord Tumors: Analysis From a National Cancer Registry

Abstract

The effect of marital status and living arrangements on health through modified health behaviors and social networks has been well-established in reported studies, with many experts claiming a "protective" effect from married life for individuals. We sought to study the effect of marital and socioeconomic status (SES) on the outcomes of patients with spinal cord tumors. The Surveillance, Epidemiology, and End Results program was queried for patients with spinal cord tumors from 2004 to 2014. Patients were separated into 4 groups according to their marital status: single/never married, married/living together, divorced/separated, and widowed. SES was calculated using a validated method. Kaplan-Meier curves and multivariable logistic and Cox regression analyses were used to investigate the relationship between marital status and SES and the mortality rate of patients with available follow-up information. Of the 1188 patients identified (683 women [57.5%] and 505 men [42.5%]), 241 (20.3%) were in the single group, 732 (61.6%) in the married/living together, 109 (9.2%) in the divorced/separated, and 106 (8.9%) in the widowed group. Compared with married patients, divorced/separated and widowed patients had a greater mortality rate (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.1-2.9; P=0.02; HR, 2.01; 95% CI, 1.3-3.1; P= 0.001, respectively). Male sex compared with female was associated with lower survival (HR, 1.42; 95% CI, 1.03-1.9; P= 0.03). Patients with greater SES had a lower mortality rate (HR, 0.77; 95% CI, 0.55-1.08; P= 0.143). Unmarried and widowed status, lower SES, and male sex resulted in a greater risk of mortality. These factors should be considered when tailoring the treatment plan for such patients.