Primary bone cancers (PBC) are devastating malignancies that have an estimated 3600 new cases diagnosed annually in the United States since 2020 [1], [2]. Several studies have suggested that social determinants of health (SDoH) have a crucial impact on PBC patient outcomes, particularly the influence of socioeconomic status and race-ethnicity on affecting PBC-care, such as primary surgery receipt, radiation, and chemotherapy, as well as time to and method of diagnosis [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. Despite these prior investigations, the impact of SDoH has never been investigated across all PBC subtypes and to date, only a limited number of SDoH variables have been examined with respect to PBC outcomes. Given the profound impact of SDoH has had in specific PBC cases, a detailed analysis of SDoH variable in the wider context of PBC is sorely needed.

The Center for Disease Control-Social Vulnerability Index (SVI) is a US census-based tool featuring 15 SDoH factors grouped into four SDoH subcategories that are assessed across all US Census tracts & counties, providing a wide-spanning, yet in-depth index to evaluate SDoH. Though originally developed to gauge health resources during natural disasters, SVI has been used to investigate social vulnerabilities in cardiovascular health and COVID-19 [13], [14], [15], [16]. Though the SVI has been previously used in oncologic studies [17], [18], [19], [20], [21], it has never been applied in PBC. In this study, we applied the SVI to determine the composite impact of socioeconomic status, minority-language status, household composition, and housing-transportation on the clinical outcomes of PBC patients across the US. Furthermore, we assessed the quantifiable differences in impact on PBC disparities among each of these SDoH subcategories.