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Effect of race, sex, and socioeconomic factors on overall survival following the resection of intramedullary spinal cord tumors

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Abstract

Introduction

Intramedullary spinal cord tumors (IMSCTs) account for 2–4% of all primary CNS tumors. Given their low prevalence and the intricacy of their diagnosis and management, it is critical to address the surrounding racial and socioeconomic factors that impact the care of patients with IMSCTs. This study aimed to investigate the association between race and socioeconomic factors with overall 5 year mortality following the resection of IMSCTs.

Methods

The study used the National Cancer Database to retrospectively analyze patients who underwent resection of IMSCTs from 2004 to 2017. Patients were divided into four cohorts by race/ethnicity, facility type, insurance, median income quartiles, and living area. The primary outcome of interest was 5 year survival, and secondary outcomes included postoperative length of stay and 30 day readmission. Descriptive and multivariable analyses were used to identify independent factors associated with mortality, with statistical significance assessed at a 2-sided p < 0.05.

Results

We evaluated the patient characteristics and outcomes for 8,028 patients who underwent surgical treatment for IMSCTs between 2004 and 2017. Most patients were white males (52.4%) with a mean age of 44 years where 7.17% of patients were Black, 7.6% were Hispanic, and 3% were Asian. Most were treated in an academic/research program (72.4%) and had private insurance (69.2%). Black patients had a higher odd of 5 year mortality (OR 1.4; 95% CI 1.1 to 1.77; p = 0.04) compared to white patients, while no significant differences in mortality were observed among other races. Factors associated with lower odds of mortality included being female (OR 0.89; 95% CI 0.78 to 1.02; p < 0.01), receiving treatment in an academic/research program (OR 0.51; 95% CI 0.33 to 0.79; p = 0.04), having private insurance (OR 0.65; 95% CI 0.45 to 0.93; p = 0.02), and having higher income quartiles (OR 0.77; 95% CI 0.62 to 0.96; p = 0.02).

Conclusion

Our study sheds light on the healthcare disparities that exist in the surgical management of IMSCTs. Our findings indicate that race, sex, socioeconomic status, and treatment facility are independent predictors of 5 year mortality, with Black patients, males, those with lower socioeconomic status, and those treated at non-academic centers experiencing significantly higher mortality rates. These alarming disparities underscore the urgent need for policymakers and researchers to address the underlying factors contributing to these discrepancies and provide equal access to high-quality surgical care for patients with IMSCTs.

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Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA

    Oluwaseun O. Akinduro, Kingsley Abode-Iyamah & Alfredo Quinones-Hinojosa

  2. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA

    Abdul Karim Ghaith, Marc Ghanem, Antonio Bon Nieves & Mohamad Bydon

  3. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Abdul Karim Ghaith, Marc Ghanem, Antonio Bon Nieves & Mohamad Bydon

  4. Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden

    Victor Gabriel El-Hajj

  5. School of Public Health, Imperial College London, London, UK

    Fatima Soltan

  6. Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

    John H. Shin

  7. Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA

    Ziya L. Gokaslan

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  1. Oluwaseun O. Akinduro
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Contributions

OOA and AG wrote the main manuscript text, VH who portions of the manuscript text, MG, FS and AN prepared the figures and tables, KA, JS, ZG, AQ and MB critically revised the manuscript. All authors reviewed the manuscript.

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Correspondence to Mohamad Bydon.

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Akinduro, O.O., Ghaith, A.K., El-Hajj, V.G. et al. Effect of race, sex, and socioeconomic factors on overall survival following the resection of intramedullary spinal cord tumors. J Neurooncol 164, 75–85 (2023). https://doi.org/10.1007/s11060-023-04373-9

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