The association between socioeconomic position and tumour size, grade, stage, and mortality in Danish sarcoma patients – A national, observational study from 2000 to 2013

Figures & data

Figure 1. Hypothesised causal relations between the socioeconomic position (educational level, disposable income and cohabitation status) and grade, stage and tumour size at time of diagnosis.

Table 1. Patient characteristics for the 1919 sarcoma patients diagnosed with sarcoma in Denmark 2000–2013.

Characteristics	Sarcoma cohort
N	1919
Gender
Men	1058 (55%)
Women	861 (45%)
Age
30–49	511 (27%)
50–69	823 (43%)
≥70 years	584 (30%)
Type
Soft tissue sarcoma	1497 (78%)
Bone sarcoma	383 (20%)
Missing	39 (2%)
Tumour size
All sarcomas, mean (n = 1626)	9.0 cm (1.0–52.0 cm)
Missing	293
Soft tissue sarcoma, mean (n = 1306)	9.2 cm (1.0–45.0 cm)
Soft tissue sarcoma <5 cm	361 (27.6%)
Soft tissue sarcoma ≥5 cm	945 (72.4%)
Bone sarcoma, mean (n = 320)	8.3 cm (1.0–52.0 cm)
Bone sarcoma < 8 cm	137 (42.8%)
Bone sarcoma ≥ 8 cm	183 (57.2%)
Soft tissue sarcoma <5 cm AND bone sarcoma < 8 cm	528 (32.5%)
Soft tissue sarcoma ≥5 cm AND bone sarcoma ≥ 8 cm	1098 (67.5%)
Stage at diagnosis
Localised	1695 (88%)
Metastatic	224 (12%)
Malignancy grade
Grade 1	462 (24.1%)
Grade 2 + 3	1289 (67.2%)
Missing	168 (8.7%)
Socioeconomic position:
Education
≤ 10 years	604 (34%)
10–15 years	752 (42%)
>15 years	418 (24%)
Income
20% lowest income	381 (20%)
Middle income	1143 (60%)
20% highest income	395 (20%)
Civil status
Single	754 (40%)
Married	1152 (60%)
Family type (Cohabitation)
Living Alone	622 (33%)
Cohabitating	1284 (67%)
Comorbidity:
No	1505 (78%)
Yes	414 (22%)

Table 2a. Associations (odds ratios (ORs) with corresponding 95% confidence intervals (CI)) between socioeconomic position and having high grade (grade II + III) sarcoma in 1751 patients aged ≥30 years in Denmark, 2000–2013.

	All sarcomas		Soft tissue sarcomas		Bone sarcomas
	Crude	Adjusted*	Crude	Adjusted*	Crude	Adjusted*
	(n = 1751)	(n = 1751)	(n = 1376)	(n = 1376)	(n = 349)	(n = 349)
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR* (95% CI)
Educational level
Short (≤ 10 years)	1.43 (1.06–1.93)	1.21 (0.87–1.66)	1.52 (1.08–2.15)	1.34 (0.93–1.93)	1.16 (0.62–2.18)	0.91 (0.46–1.80)
Medium (10-15 years)	0.99 (0.75–1.30)	0.92 (0.69–1.23)	0.98 (0.71–1.35)	0.95 (0.68–1.33)	0.97 (0.55–1.73)	0.82 (0.45–1.48)
Higher (>15 years)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)
Disposable income
Lowest income (lowest 20%)	1.31 (0.93–1.84)	1.01 (0.68–1.51)	1.39 (0.94–2.03)	0.95 (0.60–1.51)	1.03 (0.48–2.17)	1.27 (0.54–2.98)
Middle income (middle 60%)	1.03 (0.78–1.35)	1.04 (0.77–1.39)	1.02 (0.75–1.38)	0.94 (0.67–1.32)	1.15 (0.64–2.07)	1.47 (0.79–2.74)
Highest income (highest 20%)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)
Cohabitation status
Living alone	1.21 (0.96–1.52)	1.03 (0.80–1.33)	1.38 (1.05–1.79)	1.17 (0.87–1.57)	0.78 (0.47–1.28)	0.71 (0.41–1.22)
Cohabitating	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)

*Adjusted for age, gender, comorbidity, and the socioeconomic indicators.

Statistically significant results in bold.

Table 2b. Association (odds ratios (ORs) with corresponding 95% confidence intervals (CI)) between socioeconomic position, and disseminated sarcoma in 1919 patients aged ≥30 years in Denmark, 2000–2013.

	All sarcomas		Soft tissue sarcomas		Bone sarcomas
	Crude	Adjusted*	Crude	Adjusted*	Crude	Adjusted*
	(n = 1919)	(n = 1919)	(n = 1497)	(n = 1497)	(n = 383)	(n = 383)
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Educational level
Short (≤ 10 years)	1.14 (0.78–1.68)	1.04 (0.69–1.58)	1.27 (0.81–2.00)	1.20 (0.73–1.95)	1.07 (0.47–2.43)	0.84 (0.34–2.05)
Medium (10-15 years)	1.06 (0.73–1.54)	1.08 (0.73–1.58)	1.13 (0.72–1.77)	1.18 (0.74–1.87)	1.01 (0.47–2.17)	0.92 (0.42–2.03)
Higher (>15 years)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)
Disposable income
Lowest income (lowest 20%)	1.02 (0.66–1.56)	1.05 (0.64–1.72)	1.04 (0.64–1.69)	1.03 (0.59–1.80)	1.37 (0.52–3.61)	1.43 (0.48–4.28)
Middle income (middle 60%)	0.92 (0.65–1.31)	0.82 (0.56–1.20)	0.94 (0.62–1.41)	0.78 (0.50–1.22)	0.87 (0.39–1.94)	0.86 (0.37–2.01)
Highest income (highest 20%)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)
Cohabitation status
Living alone	1.05 (0.78–1.41)	1.06 (0.77–1.46)	1.22 (0.87–1.70)	1.24 (0.86–1.79)	0.75 (0.36–1.53)	0.74 (0.35–1.57)
Cohabitating	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)	1.00 (reference)

*Adjusted for age, gender, comorbidity, and the socioeconomic indicators.

Table 3. Associations (odds ratios (ORs) with 95% confidence intervals (CI)) between socioeconomic position, and having a larger sarcoma (≥5 and ≥8 cm) at time of diagnosis in 1626 patients aged ≥30 years in Denmark, 2000–2013.

	Soft tissue ≥5 and bone sarcomas ≥8 cm	Soft tissue sarcoma ≥5 cm	Bone sarcoma ≥8 cm
	(n = 1626)	(n = 1306)	(n = 320)
	OR (95% CI)	OR (95% CI)	OR (95% CI)
Educational level
Short (≤ 10 years)	1.10 (0.81–1.51)	1.06 (0.74–1.53)	1.00 (0.51–1.95)
Medium (10–15 years)	0.90 (0.68–1.20)	0.96 (0.68–1.35)	0.67 (0.38–1.20)
Higher (>15 years)	1.00 (reference)	1.00 (reference)	1.00 (reference)
Disposable income
Lowest income (lowest 20%)	0.86 (0.58–1.26)	0.68 (0.44–1.06)	2.43 (0.99–5.95)
Middle income (middle 60%)	1.07 (0.80–1.43)	1.02 (0.73–1.43)	1.67 (0.88–3.16)
Highest income (highest 20%)	1.00 (reference)	1.00 (reference)	1.00 (reference)
Cohabitation status
Living alone	1.30 (1.01–1.67)	1.51 (1.12–2.03)	0.78 (0.46–1.34)
Cohabitating	1.00 (reference)	1.00 (reference)	1.00 (reference)

*Adjusted for age, gender, comorbidity, and the two remaining socioeconomic indicators.

Statistically significant results in bold.

Table 4. Mortality rates and crude and adjusted hazard ratios with 95% confidence intervals (CI) for all sarcoma patients (n = 1919) and stratified for socioeconomic position, age, gender, comorbidity, grade, stage, and tumour size in Denmark 2000–2019.

	Mortality rates (95% CI)	Hazard ratio (95% CI)
	5-year	Crude	Adjusted*
Education
≤ 10 years	0.44 (0.40–0.48)	1.74 (1.42–2.12)	1.27 (1.02–1.57)
10–15 years	0.34 (0.30–0.37)	1.16 (0.94–1.42)	1.01 (0.82–1.24)
>15 years	0.32 (0.27–0.37)	1.00 (reference)	1.00 (reference)
Income
20% lowest income	0.50 (0.45–0.53)	2.00 (1.62–2.48)	1.30 (1.00–1.67)
Middle income	0.38 (0.35–0.41)	1.25 (1.02–1.51)	1.10 (0.89–1.36)
20% highest income	0.32 (0.27–0.36)	1.00 (reference)	1.00 (reference)
Cohabitation
Living Alone	0.47 (0.43–0.31)	1.56 (1.36–1.80)	1.16 (0.99–1.36)
Cohabitating	0.35 (0.33–0.38)	1.00 (reference)	1.00 (reference)

* Adjusted for age, gender, comorbidity, and the two remaining socioeconomic indicators.

Statistically significant results in bold.