Social determinants of health and the prediction of 90-day mortality among brain tumor patients

Abstract

OBJECTIVE Within the neurosurgical oncology literature, the effect of structural and socioeconomic factors on postoperative outcomes remains unclear. In this study, the authors quantified the effects of social determinant of health (SDOH) disparities on hospital complications, length of stay (LOS), nonroutine discharge, 90-day readmission, and 90-day mortality following brain tumor surgery. METHODS The authors retrospectively reviewed the records of brain tumor patients who had undergone resection at a single institution in 2017–2019. The prevalence of SDOH disparities among patients was tracked using International Classification of Diseases Ninth and Tenth Revisions (ICD-9 and ICD-10) codes. Bivariate (Mann-Whitney U-test and Fisher’s exact test) and multivariate (logistic and linear) regressions revealed whether there was an independent relationship between SDOH status and postoperative outcomes. RESULTS The patient cohort included 2519 patients (mean age 55.27 ± 15.14 years), 187 (7.4%) of whom experienced at least one SDOH disparity. Patients who experienced an SDOH disparity were significantly more likely to be female (OR 1.36, p = 0.048), Black (OR 1.91, p < 0.001), and unmarried (OR 1.55, p = 0.0049). Patients who experienced SDOH disparities also had significantly higher 5-item modified frailty index (mFI-5) scores (p < 0.001) and American Society of Anesthesiologists (ASA) classes (p = 0.0012). Experiencing an SDOH disparity was associated with a significantly longer hospital LOS (p = 0.0036), greater odds of a nonroutine discharge (OR 1.64, p = 0.0092), and greater odds of 90-day mortality (OR 2.82, p = 0.0016) in the bivariate analysis. When controlling for patient demographics, tumor diagnosis, mFI-5 score, ASA class, surgery number, and SDOH status, SDOHs independently predicted hospital LOS (coefficient = 1.22, p = 0.016) and increased odds of 90-day mortality (OR 2.12, p = 0.028). CONCLUSIONS SDOH disparities independently predicted a prolonged hospital LOS and 90-day mortality in brain tumor patients. Working to address these disparities offers a new avenue through which to reduce patient morbidity and mortality following brain tumor surgery.

Social Determinants of Health and Associations With Outcomes in Pediatric Patients With Brain Tumors

“…In the group with no SDOH disparities, there were no Black patients (0%); in the group with 1 disparity, there were 5 Black patients (4.9%); in the group with 2 disparities, there were 15 Black patients (21.1%); and in the group with 3 disparities, there were 11 Black patients (64.7%) ( P < .001). This is similarly seen in the study by Jimenez et al 9 who had an increased number of Black patients in their SDOH disparity cohort.…”

“…10 In the adult brain tumor population, the cumulative effect of disparities in SDOH was studied and several disparities in SDOH factors and various postoperative outcomes were identified. 9…”

“…Although not included in the original SDOH model, many investigators have advocated for race as an SDOH disparity because of its association with negative outcomes in specific populations. 9,10,[16][17][18] In our study, race served as the variable to examine social and community context. No data were available for analysis of the neighborhood and built environment or education access and quality.…”

“…8 A recent study demonstrated that the presence of multiple negative SDOH factors in adult patients with brain tumors was associated with significantly longer length of (hospital) stay (LOS), greater odds of nonroutine discharge, and higher 90-day mortality rates in the SDOH cohort. 9…”

“…8 A recent study demonstrated that the presence of multiple negative SDOH factors in adult patients with brain tumors was associated with significantly longer length of (hospital) stay (LOS), greater odds of nonroutine discharge, and higher 90-day mortality rates in the SDOH cohort. 9 Although Berkman et al 10 looked at SDOH in the pediatric brain tumor population, they primarily described varying outcomes between racial groups. Instead, we aimed to assess the impact of multiple SDOH disparities and their cumulative effects on outcomes of pediatric patients with brain tumors.…”