Introduction: Previous studies have demonstrated a role of race and socioeconomic status (SES) as predictors of treatment and outcomes in several neurosurgical disorders. The effect of socioeconomic determinants on outcomes in cranial meningiomas however, has not been studied.
Methods: We utilized outcomes data from the Surveillance,
Epidemiology, and End Results (SEER) program database at the
National Cancer Institute to identify 54,282 patients undergoing
treatment for meningioma between 2003 and 2012. SES was
measured by a composite index developed by Yost et al. Race
was categorized as Caucasian and non-Caucasian. Treatment
received included surgery, radiation, and radiation with surgery.
Odds of receiving surgery and survival probability were analyzed
using multivariate logistic regression and Cox proportional hazards
model, respectively.
Results: 73% of the study population was female. Mean age at diagnosis
was 64 years and 15% of patients received gross total resection,
26% achieved ‘other surgery,’ while 58% received no surgery.
High SES tertile (OR = 1.112; 95% CI 1.103-1.220; p = 0.03) and
high SES quintile (OR = 1.067; 95% CI 1.011-1.125; p = 0.02)
were both predictors of gross total resection after being adjusted
for age at diagnosis, sex, race and tumor grade (World Health
Organization System). Higher SES did not correlate with any
survival difference (p=0.22 after being adjusted for age at
diagnosis, sex, race and tumor grade). Neither race nor
gender affected likelihood to receive a particular treatment
modality (surgery and/or radiation).
Conclusions: This study suggests socioeconomic status is an independent predictor of receiving gross total resection for meningiomas, after being adjusted for multiple covariates including age, sex, race, and tumor grade. Further investigation is required to understand possible reasons for this association, and how disparities in health services and outcomes can be addressed across the population.
Patient Care: We aim to highlight disparities in outcomes of 'at risk' populations of neurosurgical patients in the hope of increasing their access to care nationally.
Learning Objectives: Describe the different methods of stratifying patients based on socioeconomic status.
Discuss the role of socioeconomic status on gross total resection in meningioma patients.