Survival Disparity Based on Household Income in 1970 Patients Following Brain Tumor Surgery.

Abstract

The impact of household economics on outcomes is not well understood. We examined the relationship of income and surgical outcomes, after controlling for numerous patient characteristics. Consecutive adult (≥18) patients (n = 1970, June 2013-April 2019) undergoing supratentorial brain tumor resection, at a single health system, were assessed. Univariate logistic regression was performed to assess the impact of household income on patient survival. The cohort was then separated into income quartiles (range: $18,119-$193,152). The lowest (Q1) and highest (Q4) income quartiles were then compared. Patients (Q1/Q4) subsequently underwent 1:1 coarsened exact matching based on a number of patient characteristics. Outcomes included mortality, emergency evaluations, and readmissions. Regression analysis of all 1970 patients demonstrated increasing survival with increasing household income (mortality 30-day P = 0.027, 90-day P = 0.002). Logistic regression of all Q1 versus Q4 patients (n = 970) demonstrated increased survival for the highest income patients (Q4) (mortality 30-day P = 0.220, 90-day P = 0.028, all follow-up P = 0.027). Analysis of exact-matched patients (Q1 vs. Q4; n = 462), demonstrated higher income was associated with escalating, nonsignificant, survival rates at 30 (mortality 3.90% Q1 vs. 2.60% Q4, P = 0.424) and 90 days (mortality 13.42% Q1 vs. 8.66 Q4, P = 0.101) but significantly increased survival during total follow-up (mortality Q1 46.75%, Q4 35.06%, P = 0.010). No significant difference was noted for the remaining studied outcomes. Patients matched on a multitude of characteristics, of lesser household income, had higher long-term mortality after brain tumor resection. Further understanding of this disparity should be sought and differences mitigated.