Neighborhood disadvantage is associated with treatment access outcomes and survival among individuals with a primary brain tumor.

Abstract

Background: Neighborhood disadvantage is linked to lower rates of healthcare access. To understand how residence affects the primary brain tumor (PBT) population, we assessed neighborhood disadvantage and population density with treatment access outcomes among a cohort of 666 adult participants with a PBT and study entry data in a large observational study at the National Institutes of Health (NIH) (NCT#: NCT02851706).

Methods: We assessed neighborhood disadvantage (measured by the area deprivation index [ADI]) and population density with symptom duration before diagnosis and time to treatment using ordinal logistic and linear regression. Kaplan-Meier survival curves were estimated by population density and ADI, overall and stratified by residential distance to the NIH, tumor grade, and age.

Results: Among 666 participants, 24% lived in more disadvantaged areas. Among the overall sample, there were no associations between ADI or population density with symptom duration, but the time to any treatment was longer for patients living in more disadvantaged neighborhoods (β = 7.78; 95% confidence interval [CI] = 0.02, 15.55), especially among those with low-grade PBTs (β = 36.19; 95%CI = 12.17, 60.20). Time to treatment was longer for those in nonurbanized areas and further from the NIH (β = 0.63; 95% CI = 0.08, 1.17). Patients living in more disadvantaged neighborhoods had higher 5-year survival compared with patients living in less disadvantaged neighborhoods (P = .02).

Conclusions: Individuals with low-grade PBTs living in more disadvantaged neighborhoods and further from NIH had a longer time to treatment. Future efforts should focus on strategies to reach patients living in disadvantaged neighborhoods.