Skip to main content
SpringerLink
Log in

Association of area deprivation index (ADI) with demographics and postoperative outcomes in pediatric brain tumor patients

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Although social determinants of health (SDOH) have been associated with adverse surgical outcomes, cumulative effects of multiple SDOH have never been studied. The area deprivation index (ADI) assesses cumulative impact of SDOH factors on outcomes. We analyzed the relationship between ADI percentile and postoperative outcomes in pediatric patients diagnosed with brain tumors.

Methods

A retrospective, observational study was conducted on our consecutive series of pediatric brain tumor patients presenting between January 1, 1999, and May 31, 2022. Demographics and outcomes were collected, identifying SDOH factors influencing outcomes found in the literature. ADI percentiles were identified based on patient addresses, and patients were stratified into more (ADI 0–72%) and less (ADI 73–100%) disadvantaged cohorts. Univariate and multivariate logistic regression analyses were completed for demographics and outcomes.

Results

A total of 272 patients were included. Demographics occurring frequently in the more disadvantaged group were Black race (13.1% vs. 2.8%; P = .003), public insurance (51.5% vs. 27.5%; P < .001), lower median household income ($64,689 ± $19,254 vs. $46,976 ± $13,751; P < .001), and higher WHO grade lesions (15[11.5%] grade III and 8[6.2%] grade IV vs. 8[5.6%] grade III and 5[3.5%] grade IV; P = .11). The more disadvantaged group required adjunctive chemotherapy (25.4% vs. 12.05%; P = .007) or radiation therapy (23.9% vs. 12.7%; P = .03) more frequently and had significantly greater odds of needing adjunctive chemotherapy (odds ratio [OR], 1.11; confidence interval [CI], 1.01–1.22; P = .03) in a multivariate model, which also identified higher WHO tumor grades at presentation (OR, 1.20; CI, 1.14–1.27; P < .001).

Conclusion

These findings are promising for use of ADI to represent potential SDOH disadvantages that pediatric patients may face throughout treatment. Future studies should pursue large multicenter collaborations to validate these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The data availabilty statement is the last sentence of the "Data collection" section of the Methods. Please advise if this should be located elsewhere. 

Abbreviations

ADI:

Area deprivation index

CI:

Confidence interval

SDOH:

Social determinants of health

OR:

Odds ratio

STROBE:

Strength in Reporting of Observational Studies in Epidemiology

WHO:

World Health Organization

References

  1. World Health Organization (2022) Social determinants of health https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1. Accessed 01 Nov 2022

  2. Berg AT, Baca CB, Rychlik K, Vickrey BG, Caplan R, Testa FM, Levy SR (2016) Determinants of social outcomes in adults with childhood-onset epilepsy. DOI https://doi.org/10.1542/peds.2015-3944 epub March 18. Pediatrics 137: e20153944

  3. Berkman JM, Dallas J, Lim J, Bhatia R, Gaulden A, Gannon SR, Shannon CN, Esbenshade AJ, Wellons JC (2019) Social determinants of health affecting treatment of pediatric brain tumors. J Neurosurg Pediatr 24:159–165

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jimenez AE, Cicalese KV, Chakravarti S, Porras JL, Azad TD, Jackson CM, Gallia GL, Bettegowda C, Weingart J, Mukherjee D (2022) Social determinants of health and the prediction of 90-day mortality among brain tumor patients. https://doi.org/10.3171/2022.1.Jns212829. J Neurosurg epub March 11: 1–9

  5. Khalid SI, Maasarani S, Nunna RS, Shanker RM, Cherney AA, Smith JS, Reme AI, Adogwa O (2021) Association between social determinants of health and postoperative outcomes in patients undergoing single-level lumbar fusions: a matched analysis. Spine (Phila Pa 1976) 46: E559-e565

  6. Spadola M, Farooqi A, Dimentberg R, Blue R, Shultz K, McClintock SD, Malhotra N (2020) The effect of household income on outcomes following supratentorial meningioma resection. Clin Neurol Neurosurg 195:106031

    Article  PubMed  Google Scholar 

  7. Blue R, Dimentberg R, Detchou DK, Glauser G, Shultz K, McClintock S, Malhotra NR (2020) The impact of household economics on short-term outcomes in a posterior fossa tumor population. Cureus 12:e8968

    PubMed  PubMed Central  Google Scholar 

  8. Tang OY, Clarke RA, Rivera Perla KM, Corcoran Ruiz KM, Toms SA, Weil RJ (2022) Brain tumor craniotomy outcomes for dual-eligible medicare and medicaid patients: a 10-year nationwide analysis. J Neurooncol 156:387–398

    Article  PubMed  Google Scholar 

  9. Lopez Ramos C, Brandel MG, Steinberg JA, Wali AR, Rennert RC, Santiago-Dieppa DR, Sarkar RR, Pannell JS, Murphy JD, Khalessi AA (2019) The impact of traveling distance and hospital volume on post-surgical outcomes for patients with glioblastoma. J Neurooncol 141:159–166

    Article  PubMed  Google Scholar 

  10. Safford MM, Reshetnyak E, Sterling MR, Richman JS, Muntner PM, Durant RW, Booth J, Pinheiro LC (2021) Number of social determinants of health and fatal and nonfatal incident coronary heart disease in the REGARDS study. Circulation 143:244–253

    Article  PubMed  Google Scholar 

  11. Durfey SNM, Kind AJH, Buckingham WR, DuGoff EH, Trivedi AN (2019) Neighborhood disadvantage and chronic disease management. Health Serv Res 54(Suppl 1):206–216

    Article  PubMed  Google Scholar 

  12. Kind AJ, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, Greenberg C, Smith M (2014) Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med 161:765–774

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zuelsdorff M, Larson JL, Hunt JFV, Kim AJ, Koscik RL, Buckingham WR, Gleason CE, Johnson SC, Asthana S, Rissman RA, Bendlin BB, Kind AJH (2020) The Area deprivation index: a novel tool for harmonizable risk assessment in Alzheimer’s disease research. Alzheimers Dement (N Y) 6:e12039

    Article  PubMed  Google Scholar 

  14. University of Wisconsin Center for Health Disparities Research (2020) Neighborhood Atlas https://www.neighborhoodatlas.medicine.wisc.edu. Accessed 10 Oct 2022

  15. Deng X, Yang X, Yang C, Chen K, Ren J, Zeng J, Zhang Q, Li T, Tang Q, Zhu J (2022) Socioeconomic deprivation and survival outcomes in primary central nervous system lymphomas. Front Oncol 12:929585

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hagan MJ, Sastry RA, Feler J, Shaaya EA, Sullivan PZ, Abinader JF, Camara JQ, Niu T, Fridley JS, Oyelese AA, Sampath P, Telfeian AE, Gokaslan ZL, Toms SA, Weil RJ (2022) Neighborhood-level socioeconomic status predicts extended length of stay after elective anterior cervical spine surgery. World Neurosurg 163:e341–e348

    Article  PubMed  Google Scholar 

  17. Rivera Perla KM, Tang OY, Durfey SNM, Vivas-Buitrago T, Sherman WJ, Parney I, Uhm JH, Porter AB, Elinzano H, Toms SA, Quiñones-Hinojosa A (2022) Predicting access to postoperative treatment after glioblastoma resection: an analysis of neighborhood-level disadvantage using the area deprivation index (ADI). J Neurooncol 158:349–357

    Article  PubMed  Google Scholar 

  18. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349

    Article  Google Scholar 

  19. United States Census Bureau (2018) Median income in the past 12 months (IN 2018 INFLATION-ADJUSTED DOLLARS). https://data.census.gov/cedsci/table?q=median%20household%20income&tid=ACSST5Y2018.S1903. Accessed 27 Sept 2022

  20. Jensen MM, Jørgensen JT, Binderup T, Kjaer A (2008) Tumor volume in subcutaneous mouse xenografts measured by microCT is more accurate and reproducible than determined by 18F-FDG-microPET or external caliper. BMC Med Imaging 8:16

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sápi J, Kovács L, Drexler DA, Kocsis P, Gajári D, Sápi Z (2015) Tumor volume estimation and quasi-continuous administration for most effective bevacizumab therapy. PLoS ONE 10:e0142190

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tomayko MM, Reynolds CP (1989) Determination of subcutaneous tumor size in athymic (nude) mice. Cancer Chemother Pharmacol 24:148–154

    Article  CAS  PubMed  Google Scholar 

  23. Hu J, Kind AJH, Nerenz D (2018) Area deprivation index predicts readmission risk at an urban teaching hospital. Am J Med Qual 33:493–501

    Article  PubMed  PubMed Central  Google Scholar 

  24. Khayat Kashani HR, Alizadeh P, Salimi S, Habtemariam S, Khayatkashani M, Tewari D (2022) Epidemiologic profile and outcome of primary pediatric brain tumors in Iran: retrospective study and literature review. Childs Nerv Syst 38:353–360

    Article  PubMed  Google Scholar 

  25. DeAngelis LM (2003) Benefits of adjuvant chemotherapy in high-grade gliomas. Semin Oncol 30:15–18

    Article  CAS  PubMed  Google Scholar 

  26. Lonardi S, Tosoni A, Brandes AA (2005) Adjuvant chemotherapy in the treatment of high grade gliomas. Cancer Treat Rev 31:79–89

    Article  CAS  PubMed  Google Scholar 

  27. Majd N, Penas-Prado M (2019) Updates on management of adult medulloblastoma. Curr Treat Options Oncol 20:64

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Paul H. Dressel BFA for preparation of the illustration and Carrie Owens MSILS and Debra J. Zimmer for editorial support.

Author information

Authors and Affiliations

  1. Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA

    Alexander O. Aguirre, Nicco Ruggiero & Manhal Siddiqi

  2. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA

    Jaims Lim, Ammad A. Baig, Matthew J. Recker, Veetai Li & Renée M. Reynolds

  3. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA

    Jaims Lim, Ammad A. Baig & Matthew J. Recker

  4. Department of Neurosurgery, John R. Oishei Children’s Hospital, Buffalo, NY, USA

    Veetai Li & Renée M. Reynolds

Authors
  1. Alexander O. Aguirre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaims Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ammad A. Baig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicco Ruggiero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manhal Siddiqi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthew J. Recker
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Veetai Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Renée M. Reynolds
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Alexander O. Aguirre, Jaims Lim, and Renée M. Reynolds contributed to the study conception and design. Acquisition and interpretation of data were performed by all authors. Statistical analysis was performed by Alexander O. Aguirre. The first draft of the manuscript was written by Alexander O. Aguirre and Jaims Lim and all authors critically revised and reviewed and approved the submitted version of the manuscript. The study was supervised by Renée M. Reynolds and Veetai Li.

Corresponding author

Correspondence to Renée M. Reynolds.

Ethics declarations

Ethical approval

This study has been approved by the University at Buffalo Institutional Review Board (STUDY00006745). At the time of hospital admission, informed consent for patient information to be published was provided by each patient or a legally authorized representative. Consent was obtained from patients or a legally authorized representative before procedures were performed.

Competing interests

The authors have no personal, financial, or institutional interest in the materials or devices described in this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aguirre, A.O., Lim, J., Baig, A.A. et al. Association of area deprivation index (ADI) with demographics and postoperative outcomes in pediatric brain tumor patients. Childs Nerv Syst 40, 79–86 (2024). https://doi.org/10.1007/s00381-023-06098-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-023-06098-6

Keywords

Search

Navigation