Individual- and Community-Level Social Determinant Associations With Acoustic Neuroma Disparities in the United States.

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Otology & Neurotology Pub Date : 2025-02-01 Epub Date: 2024-11-20 DOI:10.1097/MAO.0000000000004385

David J Fei-Zhang, Rishabh Sethia, Cyrus W Abrahamson, Olivia K Sosnoski, Anthony M Sheyn, Jill N D'Souza, Daniel C Chelius, Jeffrey C Rastatter

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引用次数: 0

Abstract

Objective: This investigation aims to determine whether community-level social determinants of health (SDoH) influenced acoustic neuroma outcomes more profoundly than individual-level SDoH through the use of multivariate models and census-level socioeconomic status (SES) measures.

Study design: Observational, retrospective cohort study. Setting: Specially Authorized Head-Neck SEER 2020 Dataset.

Patients: 23,330 adult (20+ yr) patients diagnosed with acoustic neuroma from 2010 to 2018.

Main outcome measures: Age-adjusted multivariate regressions and hazard models were performed for individual level (sex, race-ethnicity) and community-level factors (Yost Index-SES, rurality-urbanicity) to assess for differences in acoustic neuroma treatment, including delay of intervention, treatment receipt, and overall survival.

Results: Lower Yost-SES/community-level SES had a markedly positive association with an increase in all-cause mortality (HR, 1.55; 95% CI, 1.41-1.71) and negative association with stereotactic radiotherapy treatment (OR, 0.93; 95% CI, 0.86-0.99; p = 0.040). Patients with poor Yost-SES had a significantly positive association with receipt of surgical resection (OR, 1.13; 95% CI, 1.07-1.20; p < 0.001).

Conclusions: Data generated from this investigation suggest that community-level SDoH, particularly Yost-SES, have more detrimental care and prognostic disparities in acoustic neuroma treatment compared with individual-level factors.

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美国听神经瘤差异的个体和社区社会决定因素。

目的：本研究旨在通过使用多变量模型和人口普查水平的社会经济地位（SES）测量，确定社区水平的健康社会决定因素（SDoH）是否比个人水平的SDoH更深刻地影响听神经瘤的预后。研究设计：观察性、回顾性队列研究。设置：特别授权头颈部SEER 2020数据集。患者：2010年至2018年诊断为听神经瘤的23,330名成人（20岁以上）患者。主要结果测量：对个体水平（性别、种族）和社区水平因素（Yost Index-SES、乡村性-城市化）进行年龄调整多变量回归和风险模型，以评估听神经瘤治疗的差异，包括干预延迟、治疗接受和总生存率。结果：较低的Yost-SES/社区水平的SES与全因死亡率的增加呈显著正相关(HR, 1.55；95% CI, 1.41-1.71)，与立体定向放疗呈负相关(OR, 0.93；95% ci, 0.86-0.99；P = 0.040)。Yost-SES差的患者与接受手术切除有显著正相关(OR, 1.13；95% ci, 1.07-1.20；P < 0.001)。结论：本研究的数据表明，与个人因素相比，社区水平的SDoH，特别是Yost-SES，在听神经瘤治疗中存在更大的不利护理和预后差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Otology & Neurotology 医学-耳鼻喉科学

CiteScore

3.80

自引率

14.30%

发文量

509

审稿时长

3-6 weeks

期刊介绍： Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and cranial base surgery. As the foremost journal in its field, it has become the favored place for publishing the best of new science relating to the human ear and its diseases. The broadly international character of its contributing authors, editorial board, and readership provides the Journal its decidedly global perspective.