Association Between Urbanicity and Outcomes Among Patients with Spinal Cord Ependymomas in the United States.

CBTRUS Intramedullary spinal cord tumor Spinal cord ependymoma Urbanicity

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
22 Aug 2023
Historique:
received: 10 08 2023
revised: 13 08 2023
accepted: 14 08 2023
pubmed: 25 8 2023
medline: 25 8 2023
entrez: 24 8 2023
Statut: aheadofprint

Résumé

Spinal cord ependymomas (SCEs) represent the most common intramedullary spinal cord tumors among adults. Research shows that access to neurosurgical care and patient outcomes can be greatly influenced by patient location. This study investigates the association between the outcomes of patients with SCE in metropolitan and nonmetropolitan areas. Cases of SCE between 2004 and 2019 were identified within the Central Brain Tumor Registry of the United States, a combined dataset including the Centers for Disease Control and Prevention's National Program of Cancer Registries and National Cancer Institute's Surveillance, Epidemiology, and End Results Program data. Multivariable logistic regression models were constructed to evaluate the association between urbanicity and SCE treatment, adjusted for age at diagnosis, sex, race and ethnicity. Survival data was available from 42 National Program of Cancer Registries (excluding Kansas and Minnesota, for which county data are unavailable), and Cox proportional hazard models were used to understand the effect of surgical treatment, county urbanicity, age at diagnosis, and the interaction effect between age at diagnosis and surgery, on the survival time of patients. Overall, 7577 patients were identified, with 6454 (85%) residing in metropolitan and 1223 (15%) in nonmetropolitan counties. Metropolitan and nonmetropolitan counties had different age, sex, and race/ethnicity compositions; however, demographics were not associated with differences in the type of surgery received when stratified by urbanicity. Irrespective of metropolitan status, individuals who were American Indian/Alaska Native non-Hispanic and Hispanic (all races) were associated with reduced odds of receiving surgery. Individuals who were Black non-Hispanic and Hispanic were associated with increased odds of receiving comprehensive treatment. Diagnosis of SCE at later ages was linked with elevated mortality (hazard ratio = 4.85, P < 0.001). Gross total resection was associated with reduced risk of death (hazard ratio = 0.37, P = 0.004), and age did not interact with gross total resection to influence risk of death. The relationship between patients' residential location and access to neurosurgical care is critical to ensuring equitable distribution of care. This study represents an important step in delineating areas of existing disparities.

Sections du résumé

BACKGROUND BACKGROUND
Spinal cord ependymomas (SCEs) represent the most common intramedullary spinal cord tumors among adults. Research shows that access to neurosurgical care and patient outcomes can be greatly influenced by patient location. This study investigates the association between the outcomes of patients with SCE in metropolitan and nonmetropolitan areas.
METHODS METHODS
Cases of SCE between 2004 and 2019 were identified within the Central Brain Tumor Registry of the United States, a combined dataset including the Centers for Disease Control and Prevention's National Program of Cancer Registries and National Cancer Institute's Surveillance, Epidemiology, and End Results Program data. Multivariable logistic regression models were constructed to evaluate the association between urbanicity and SCE treatment, adjusted for age at diagnosis, sex, race and ethnicity. Survival data was available from 42 National Program of Cancer Registries (excluding Kansas and Minnesota, for which county data are unavailable), and Cox proportional hazard models were used to understand the effect of surgical treatment, county urbanicity, age at diagnosis, and the interaction effect between age at diagnosis and surgery, on the survival time of patients.
RESULTS RESULTS
Overall, 7577 patients were identified, with 6454 (85%) residing in metropolitan and 1223 (15%) in nonmetropolitan counties. Metropolitan and nonmetropolitan counties had different age, sex, and race/ethnicity compositions; however, demographics were not associated with differences in the type of surgery received when stratified by urbanicity. Irrespective of metropolitan status, individuals who were American Indian/Alaska Native non-Hispanic and Hispanic (all races) were associated with reduced odds of receiving surgery. Individuals who were Black non-Hispanic and Hispanic were associated with increased odds of receiving comprehensive treatment. Diagnosis of SCE at later ages was linked with elevated mortality (hazard ratio = 4.85, P < 0.001). Gross total resection was associated with reduced risk of death (hazard ratio = 0.37, P = 0.004), and age did not interact with gross total resection to influence risk of death.
CONCLUSIONS CONCLUSIONS
The relationship between patients' residential location and access to neurosurgical care is critical to ensuring equitable distribution of care. This study represents an important step in delineating areas of existing disparities.

Identifiants

DOI: 10.1016/j.wneu.2023.08.062 PMID: 37619838
pubmed: 37619838
pii: S1878-8750(23)01174-9
doi: 10.1016/j.wneu.2023.08.062
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : NHLBI NIH HHS
ID : T32 HL151323
Pays : United States

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Jacob Sperber (J)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.

Edwin Owolo (E)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.

Nancy Abu-Bonsrah (N)

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon, Africa.

Corey Neff (C)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA; Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA.

Cesar Baeta (C)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.

Chuxuan Sun (C)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.

Tara Dalton (T)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.

David Sykes (D)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.

Brandon L Bishop (BL)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.

Carol Kruchko (C)

Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA.

Jill S Barnholtz-Sloan (JS)

Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA; Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA; Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA.

Kyle M Walsh (KM)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.

Sheng-Fu Larry Lo (SF)

Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, New York, New York, USA.

Daniel Sciubba (D)

Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, New York, New York, USA.

Quinn T Ostrom (QT)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.

C Rory Goodwin (CR)

Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: spineresearch@dm.duke.edu.

Classifications MeSH