Racial and Socioeconomic Disparities in Patients With Meningioma: A Retrospective Cohort Study

Neurosurgery - Tập 90 Số 1 - Trang 114-123 - 2022
Hudin N. Jackson1, Caroline Hadley1, A. Basit Khan1, Ron Gadot1, James C. Bayley1, Arya Shetty1, Jacob Mandel2, Ali Jalali1, Katherine Gallagher1,3, Alex D. Sweeney3, Arif Harmanci4, Akdes Serin Harmancı1, Tiemo J. Klisch5,6, Shankar Gopinath1, Ganesh Rao1, Daniel Yoshor7, Akash J. Patel1,3,6
1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
2Department of Neurology, Baylor College of Medicine, Houston, Texas USA
3Department of Otolaryngology−Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
4Center for Computational Systems Medicine, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA;
5Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.
6Jan and Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA;
7Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Tóm tắt

BACKGROUND: Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors. OBJECTIVE: To determine factors that contribute to different clinical outcomes in racial populations. METHODS: We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences. RESULTS: Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival. CONCLUSION: Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.

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Neurosurgery

Tập 90 Số 1

114-123

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