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

Abstract

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. To investigate the racial and socioeconomic differences that lead to unequal distribution of access for PAs at HVFs in the United States. Retrospective analysis of data from the National Cancer Database from 2004 to 2019 on 57 807 patients with PA. Baseline description of patients treated at HVFs, survival outcomes, and predictors of survival were evaluated in patients with PA. A total of 47.6% (n = 27 523) underwent surgery at a HVF. On multivariable analysis, African-American race [odds ratio (OR): 0.89, P < .001] and Hispanic ethnicity (OR: 0.80, P < .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 = .003; reference = urban); with Medicaid insurance (OR: 0.86, P < .001; reference = private), those with lower income [<$40 227 (OR: 0.93, P = .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 < .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 [eg, 2005 (OR = 1.10 [0.97-1.26], P = .173) vs 2019 (OR = 1.27 [1.13-1.43], P < .001)]. There are significant racial and socioeconomic disparities in access to HVFs for adult patients seeking surgical resection of pituitary adenomas.