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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.