Spanish to English Medical Medical: Health Care

Hello, could anyone offer an alternative to 'circumstance' in this phrase. It just doesn't seem to fit well.

Eso quiere decir que una importante cantidad de pacientes fluctúan entre ser diagnosticados o no, circunstancia que depende no sólo de la patología que padece, sino también de la tolerancia de la cultura que los recibe.

This means that a significant number of patients are hesitant about whether or not to obtain a diagnosis, a circumstance which depends not only on the pathology from which they suffer but also on the tolerance of the culture which recieves them.

Thanks to anyone who answers