Geographic disparities in access to glioblastoma treatment based on Hispanic ethnicity in the United States: Insights from a national database

Lu, Victor M.; Shah, Ashish H.; Eichberg, Daniel G.; Quiñones‐Hinojosa, Alfredo; Esquenazi, Yoshua; Komotar, Ricardo J.; Ivan, Michael E.

doi:10.1007/s11060-020-03480-1

Cited by 22 publications

(9 citation statements)

References 40 publications

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“…26 We found that brain tumor craniotomy SNH patients were more likely to be non-white, uninsured, and low income ( Table 3 ), which are factors that earlier studies have correlated with decreased access, adverse discharge disposition, and excess mortality. 2 , 5 , 27 Poorer outcomes in vulnerable patients may be attributed to higher rates of comorbidities and barriers like health literacy, social support, and access to preventive care. The greater frequency of patients in our study population from the highest income quartile (29.0%), compared to the lowest (20.3%), may reflect the impaired medical access and shorter overall life expectancies documented in low-income geographies.…”

Section: Discussionmentioning

confidence: 99%

The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis

Tang

Perla

Lim

et al. 2020

Neuro-Oncology Advances

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Background Outcome disparities have been documented at safety-net hospitals (SNHs), which disproportionately serve vulnerable patient populations. Using a nationwide retrospective cohort, we assessed inpatient outcomes following brain tumor craniotomy at SNHs in the United States. Methods We identified all craniotomy procedures in the National Inpatient Sample from 2002-2011 for brain tumors: glioma, metastasis, meningioma, and vestibular schwannoma. Safety-net burden was calculated as the number of Medicaid plus uninsured admissions divided by total admissions. Hospitals in the top quartile of burden were defined as SNHs. The association between SNH status and in-hospital mortality, discharge disposition, complications, hospital-acquired conditions (HACs), length of stay (LOS), and costs were assessed. Multivariate regression adjusted for patient, hospital, and severity characteristics. Results 304,719 admissions were analyzed. The most common subtype was glioma (43.8%). Of 1,206 unique hospitals, 242 were SNHs. SNH admissions were more likely to be non-white (P<0.001), low-income (P<0.001), and have higher severity scores (P=0.034). Mortality rates were higher at SNHs for metastasis admissions (odds ratio [OR]=1.48, P=0.025), and SNHs had higher complication rates for meningioma (OR=1.34, P=0.003) and all tumor types combined (OR=1.17, P=0.034). However, there were no differences at SNHs for discharge disposition or HACs. LOS and hospital costs were elevated at SNHs for all subtypes, culminating in a 10% and 9% increase in LOS and costs for the overall population, respectively (all P<0.001). Conclusions SNHs demonstrated poorer inpatient outcomes for brain tumor craniotomy. Further analyses of the differences observed and potential interventions to ameliorate interhospital disparities are warranted.

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Section: Discussionmentioning

confidence: 99%

The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis

Tang

Perla

Lim

et al. 2020

Neuro-Oncology Advances

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“…Inequities in access to high-volume facilities among Black, Hispanic, and lower socioeconomic status patients undergoing brain tumor craniotomy have been extensively documented (8,10,20). Heterogeneous geographic disparities in care and a lower likelihood of travelling large distances to high-volume hospitals, previous observations among these patient populations, may compound financial and/or logistical barriers to centralized neuro-oncological care (21)(22)(23). Socioeconomic status is often intertwined with race/ethnicity and has also been shown to influence outcomes and access to treatments for glioma patients (9,11,24).…”

Section: Discussionmentioning

confidence: 93%

Disparities in Reported Testing for 1p/19q Codeletion in Oligodendroglioma and Oligoastrocytoma Patients: An Analysis of the National Cancer Database

et al. 2021

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PurposeA chromosomal 1p/19q codeletion was included as a required diagnostic component of oligodendrogliomas in the 2016 World Health Organization (WHO) classification of central nervous system tumors. We sought to evaluate disparities in reported testing for 1p/19q codeletion among oligodendroglioma and oligoastrocytoma patients before and after the guidelines.MethodsThe National Cancer Database (NCDB) was queried for patients with histologically-confirmed WHO grade II/III oligodendroglioma or oligoastrocytoma from 2011-2017. Adjusted odds of having a reported 1p/19q codeletion test for patient- and hospital-level factors were calculated before (2011-2015) and after (2017) the guidelines. The adjusted likelihood of receiving adjuvant treatment (chemotherapy and/or radiotherapy) based on reported testing was also evaluated.ResultsOverall, 6,404 patients were identified. The reported 1p/19q codeletion testing rate increased from 45.8% in 2011 to 59.8% in 2017. From 2011-2015, lack of insurance (OR 0.77; 95% CI 0.62-0.97;p=0.025), lower zip code-level educational attainment (OR 0.62; 95% CI 0.49-0.78;p<0.001), and Northeast (OR 0.68; 95% CI 0.57-0.82;p<0.001) or Southern (OR 0.62; 95% CI 0.49-0.79;p<0.001) facility geographic region were negatively associated with reported testing. In 2017, Black race (OR 0.49; 95% CI 0.26-0.91;p=0.024) and Northeast (OR 0.50; 95% CI 0.30-0.84;p=0.009) or Southern (OR 0.42; 95% CI 0.22-0.78;p=0.007) region were negatively associated with reported testing. Patients with a reported test were more likely to receive adjuvant treatment (OR 1.73; 95% CI 1.46-2.04;p<0.001).ConclusionDespite the 2016 WHO guidelines, disparities in reported 1p/19q codeletion testing by geographic region persisted while new disparities in race/ethnicity were identified, which may influence oligodendroglioma and oligoastrocytoma patient management.

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“…GBM patients living in higher SES regions have a greater chance of receiving radiation, and those who receive this treatment have greater OS (30)(31)(32). The same can be said for GBM patients who receive triple therapy (surgery, radiation, and chemotherapy) (33,34). An additional consideration is clinical trial participation: those living in greater SES regions are more likely to participate in clinical trials (23), which is correlated with improved OS (35) and allows for more salvage therapy options.…”

Section: Discussionmentioning

confidence: 99%

Area-level socioeconomic status is positively correlated with glioblastoma incidence and prognosis in the United States

et al. 2023

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In the United States, an individual’s access to resources, insurance status, and wealth are critical social determinants that affect both the risk and outcomes of many diseases. One disease for which the correlation with socioeconomic status (SES) is less well-characterized is glioblastoma (GBM), a devastating brain malignancy. The aim of this study was to review the current literature characterizing the relationship between area-level SES and both GBM incidence and prognosis in the United States. A query of multiple databases was performed to identify the existing data on SES and GBM incidence or prognosis. Papers were filtered by relevant terms and topics. A narrative review was then constructed to summarize the current body of knowledge on this topic. We obtained a total of three papers that analyze SES and GBM incidence, which all report a positive correlation between area-level SES and GBM incidence. In addition, we found 14 papers that focus on SES and GBM prognosis, either overall survival or GBM-specific survival. Those studies that analyze data from greater than 1,530 patients report a positive correlation between area-level SES and individual prognosis, while those with smaller study populations report no significant relationship. Our report underlines the strong association between SES and GBM incidence and highlights the need for large study populations to assess SES and GBM prognosis to ideally guide interventions that improve outcomes. Further studies are needed to determine underlying socio-economic stresses on GBM risk and outcomes to identify opportunities for intervention.

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Geographic disparities in access to glioblastoma treatment based on Hispanic ethnicity in the United States: Insights from a national database

Cited by 22 publications

References 40 publications

The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis

The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis

Disparities in Reported Testing for 1p/19q Codeletion in Oligodendroglioma and Oligoastrocytoma Patients: An Analysis of the National Cancer Database

Area-level socioeconomic status is positively correlated with glioblastoma incidence and prognosis in the United States

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