Causal assessments of multilevel social determinant factors on meningioma disparities in the United States.

Abstract

Background: Prior investigations into meningioma disparities have explored associative relationships of socioeconomic status (SES) and race-ethnicity but face gaps in the range of other social determinants/drivers of health (SDoH) factors considered and sample size. Furthermore, none have explored causal relationships between SDoH-factors and outcomes. Thus, this study aims to utilize a recent, national sampling of meningioma patients incorporating comprehensive inferential and causal-mediation approaches to delineate which SDoH-factors objectively drive care and prognostic disparities.

Methods: This retrospective study of a specialized Surveillance-Epidemiology-End Results 2020 dataset for community-/census tract-level (Yost-Index, a composite SES measure and Rurality-Urbanicity) and individual-level (sex, race-ethnicity) SDoH-factors performed age-adjusted multivariate cox-hazards and logistic regressions, and covariate-adjusted causal-mediation analyses to assess differences in overall survival, treatment receipt, and delay of treatment initiation.

Results: In age-adjusted multivariate analyses of 110,042 meningioma patients from 2010-2018, lower community-level SES significantly increased overall mortality (HR 1.31, 95%CI 1.28-1.34), decreased interventional treatment receipt (Surgery-OR 0.89, 95%CI 0.87-0.91; Radiation 0.83, 0.79-0.87), and increased treatment delay (1.13, 1.09-1.16). Minoritized race/ethnicity featured increased interventional treatment receipt (Surgery 1.18, 1.15-1.22; Radiation 1.18, 1.12-1.24) and decreased treatment delay (0.90, 0.87-0.93). In covariate-adjusted causal analyses, community-level SES showed total mediation effects of race-ethnicity in influencing overall survival and negative partial mediation effects in treatment receipt and delay.

Conclusion: For overall survival, community-level SES primarily drove meningioma disparities even when accounting for other SDoH-factors. For treatment receipt and delay, race-ethnicity caused greater differences that were partially affected by community-level SES. In turn, these comprehensive analyses provide definitive causes of meningioma disparities.