Impact of Household Income on Clinical Presentation and Survival Outcomes in Patients With Metastatic Spinal Tumors: A Retrospective Cohort Study

ABSTRACT Background and Aims Metastatic spinal tumors pose substantial challenges in oncology, especially in resource‐constrained environments like Pakistan, where lower household income may affect clinical presentation and outcomes. This retrospective cohort study aimed to evaluate the association between household income level and clinical presentation, functional outcomes, and survival in adults with metastatic spinal tumors. Methods This retrospective cohort study analyzed data from 250 adult patients diagnosed with histologically confirmed metastatic spinal tumors from 2015 to 2024 at two tertiary care centers in Pakistan. Patients were stratified by household income: low ( n = 129), middle ( n = 67), and high ( n = 54). Inclusion required histologic confirmation and a minimum potential follow‐up of 12 months. Analyses were performed in R version 4.5.2 using descriptive statistics, ANOVA/ t ‐tests, chi‐square/Fisher's exact tests, logistic regression, and Cox proportional hazards models. Results Low‐income patients had significantly longer symptom duration (mean 25.1 SD 12.3 months vs. 20.2 SD 11.0 months in the middle/high‐income groups; p = 0.004, ANOVA) and higher comorbidity burden (mean CCI 2.8 SD 1.5 vs. 2.1 SD 1.1; p = 0.020, ANOVA). Median overall survival was 11.6 months (IQR: 5.2–18.4) in the low‐income group versus 16.9 months (IQR: 7.5–25.0) in the middle/high‐income groups (log‐rank p = 0.150). The adjusted hazard ratio for low versus high income was 1.27 (95% CI: 0.84–1.90; p = 0.25). Functional improvement occurred in 33.3% (43/129) of low‐income versus 31.7% (38/121) of middle/high‐income patients ( p = 0.57, chi‐square test). Complication rates were 19.4% (25/129) versus 19.8% (24/121) ( p = 1.00, chi‐square test). Conclusion Lower household income was significantly associated with delayed presentation and higher comorbidity burden. Survival did not differ significantly after multivariable adjustment for confounders. Larger prospective studies are required to confirm these findings and inform targeted interventions in low‐resource settings.