Socioeconomic Factors Associate With Access but not Survival in Neurosurgical Brain Tumor Patients.

Abstract

Database studies have identified population-level differences in neurosurgical-oncological outcomes. This study aimed to clarify these distinctions by evaluating associations between patient sociodemographics and metrics of care access, utilization, and clinical outcomes. We retrospectively reviewed a prospectively identified database of neurosurgical-oncology patients (n = 1476) over 5 years. We conducted pathology-specific, multivariate analyses to identify sociodemographics associated with access, utilization, and outcomes, then interviewed (n = 40) with newly diagnosed patients. Significant associations were found between sociodemographics (White n = 911; Hispanic/Latino n = 285; Asian n = 206; Black n = 74), sex (ANOVA P = 0.0043), age (P < 0.001), income (P < 0.001), primary language (P < 0.001), and insurance (P < 0.001). Emergent presentation and time from imaging to neurosurgical consultation were associated with English as an additional language (EAL) (P = 0.03, P = 0.03) and public insurance (P = 0.003, P = 0.003). Black patients had increased time from consultation to surgery (P = 0.011). White patients were less likely to undergo biopsy versus resection (P = 0.05). EAL was negatively associated with gross total resection (P = 0.009). Chemotherapy was negatively associated with EAL (P = 0.02), Black race (P = 0.005), and public insurance (P = 0.001). Radiotherapy was negatively associated with EAL (P = 0.04), public insurance (P = 0.001), and age (P = 0.04). Clinical outcomes did not vary by sociodemographics. Interviews identified health literacy, prior healthcare experiences, and patient-surgeon connection as strongest drivers of utilization. Demographic factors independently associate with healthcare access but not outcomes. Progression through recommended neurosurgical-oncological care is influenced by patient-neurosurgeon relationship and trust in healthcare systems.