Neighborhood Socioeconomic Disparities Impact Glioblastoma Patient Outcomes

Overview

This single-center retrospective cohort study of 1464 glioblastoma patients found that higher neighborhood socioeconomic deprivation, measured by the Area Deprivation Index (ADI), is associated with worse overall survival and disparities in treatment. Patients from highly deprived neighborhoods were more likely to be Black, have Medicaid/Medicare insurance, live farther from the treatment center, and undergo less complete tumor resection.

Background

Glioblastoma is the most common primary brain malignancy with a poor prognosis, typically a median survival of about 15 months. Socioeconomic disparities have been linked to differences in glioblastoma treatment and outcomes, but the impact of neighborhood-level socioeconomic status (SES) remains unclear. The Area Deprivation Index (ADI) is a validated measure of neighborhood disadvantage incorporating multiple socioeconomic factors. This study aimed to assess the association between neighborhood-level SES and glioblastoma survival, accounting for molecular markers such as MGMT methylation and IDH mutation status.

Data Highlights

Key Findings

• Patients with high neighborhood deprivation (top ADI quartile) were more likely to be Black and insured by Medicaid/Medicare.
• High deprivation patients more often lived farther than 60 miles from the treatment center and in rural areas.
• These patients underwent complete tumor resection less frequently (42% vs. 48%).
• No significant difference in comorbidities was observed between high and low deprivation groups.
• The median overall survival for the entire cohort was 13.7 months, with socioeconomic deprivation associated with worsened survival.
• This study is the first to link neighborhood-level socioeconomic deprivation with glioblastoma overall survival, considering molecular markers.

Clinical Implications

Clinicians should recognize that neighborhood-level socioeconomic deprivation is associated with disparities in glioblastoma treatment and survival outcomes. Efforts to improve access to complete surgical resection and timely care for patients from deprived neighborhoods may help reduce survival disparities. Incorporating neighborhood SES measures like ADI into patient risk assessments could guide targeted interventions.

Conclusion

Neighborhood socioeconomic deprivation significantly impacts glioblastoma patient outcomes, influencing treatment patterns and survival. Addressing these disparities is critical to improving equity in glioblastoma care.

References

1. Ostrom et al. 2020 -- CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States
2. Stupp et al. 2005 -- Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma
3. Weller et al. 2017 -- Socioeconomic Disparities in Glioblastoma Outcomes
4. Smith et al. 2019 -- Racial and Income Disparities in Glioblastoma Treatment
5. Jones et al. 2021 -- Disparities in Surgical and Adjuvant Therapy for Glioblastoma
6. Lee et al. 2022 -- Socioeconomic and Racial Disparities in Glioblastoma Care
7. Kind et al. 2014 -- Neighborhood Socioeconomic Status and Health Outcomes
8. Singh et al. 2015 -- Regional Bias in Socioeconomic Status Measures
9. Krieger et al. 2016 -- Generalizability of Socioeconomic Measures
10. Kind et al. 2018 -- Area Deprivation Index and Health Outcomes
11. Mujahid et al. 2019 -- Neighborhood Deprivation and Cardiovascular Outcomes
12. Singh et al. 2020 -- Socioeconomic Disparities in Surgical Specialties
13. CMS 2022 -- Use of Neighborhood Deprivation in Reimbursement Programs
14. von Elm et al. 2007 -- STROBE Statement for Observational Studies
15. Kind et al. 2017 -- Defining High Neighborhood Disadvantage Using ADI
16. Elixhauser et al. 1998 -- Comorbidity Measures for Administrative Data
17. R Core Team 2023 -- R: A Language and Environment for Statistical Computing