Characterizing Disparities in Access to Surgery for Pituitary Adenomas: A National Cancer Database Analysis.

Context: Although there is an established improved postoperative outcome for pituitary adenomas (PA) surgically resected at high-volume facilities (HVFs), access to these centers may not be equitable.

Objective: To investigate the racial and socioeconomic differences that lead to unequal distribution of access for PAs at HVFs in the United States.

Design and patients: Retrospective analysis of data from the National Cancer Database (NCDB) from 2004 to 2019 on 57,807 patients with PA.

Main outcome measures: Baseline description of patients treated at HVFs, survival outcomes, and predictors of survival were evaluated in patients with PA.

Results: A total of 47.6% (n = 27,523) underwent surgery at a HVF. On multivariable analysis, African-American race (OR: 0.89, p < 0.001) and Hispanic ethnicity (OR: 0.80, p < 0.001) had significantly lower odds of having a surgical procedure at a HVF, as compared to a reference Caucasian population. Patients from rural locations (OR: 0.79, p = 0.003; reference = urban); with Medicaid insurance (OR: 0.86, p < 0.001; reference = private); those with lower-income (< $40,227 [OR: 0.93, p = 0.049]; reference = ≥ $63,333); and patients from zip codes with large percentages of adults who did not graduate high school (≥ 17.6% [OR: 0.95, p < 0.001]; reference = < 6.3%) were significantly less likely to have surgery at a HVF. An increasing trend in access to surgical care at HVFs for PA patients over time was demonstrated (e. g., 2005 [OR = 1.10 (0.97-1.26, p = 0.173] vs. 2019 [OR = 1.27 (1.13-1.43), p < 0.001]).

Conclusion: There is significant racial and socioeconomic disparities in access to HVFs for adult patients seeking surgical resection of pituitary adenomas.