Socioeconomic Factors Associate with Access but not Survival in Neurosurgical Brain Tumor Patients.

Abstract

Objective: Database studies have identified population-level differences in neurosurgical-oncological outcomes. This study aimed to clarify these distinctions by evaluating associations between patient sociodemographics and metrics of care access, utilization, and clinical outcomes.

Methods: We retrospectively reviewed a prospectively-identified database of neurosurgical-oncology patients (n=1476) over 5 years. We conducted pathology-specific, multivariate analyses to identify sociodemographics associated with access, utilization, and outcomes; then interviewed (n=40) with newly diagnosed patients.

Results: Significant associations were found between sociodemographics (White n=911; Hispanic/Latino n=285; Asian n=206; Black n=74), sex (ANOVA p=.0043), age (p<.001), income (p<.001), primary language (p<.001), and insurance (p<.001). Emergent presentation and time from imaging to neurosurgical consultation were associated with English as an additional language (EAL) (p=.03, p=.03) and public insurance (p=.003, p=.003). Black patients had increased time from consultation to surgery (p=.011). White patients were less likely to undergo biopsy versus resection (p=.05). EAL was negatively associated with gross total resection (p=.009). Chemotherapy was negatively associated with EAL (p=.02), Black race (p=.005), and public insurance (p=.001). Radiotherapy was negatively associated with EAL (p=.04), public insurance (p=.001), and age (p=.04). Clinical outcomes did not vary by sociodemographics. Interviews identified health literacy, prior healthcare experiences, and patient-surgeon connection as strongest drivers of utilization.

Conclusions: Demographic factors independently associate with healthcare access but not outcomes. Progression through recommended neurosurgical-oncological care is influenced by patient-neurosurgeon relationship and trust in healthcare systems.