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J Neurol Surg B Skull Base
DOI: 10.1055/a-2596-3916
Original Article

Individual and Community-Level Social Determinant Associations with Skull Base Chordoma and Chondrosarcoma Disparities in the United States

Authors

  • David J. Fei-Zhang  ‡   *

    1   Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

  • Rishabh Sethia‡   *

    2   Department of Otolaryngology—Head and Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
    3   Department of Otolaryngology - Head and Neck Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States

  • Atharva Desai‡   *

    4   University of Missouri-Kansas City School of Medicine, Kansas City, Kansas, United States

  • Anthony M. Sheyn

    5   Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States

  • Jill N. D'Souza

    6   Louisiana State University Health Sciences Center Department of Otolaryngology and Division of Pediatric Otolaryngology Children's Hospital of New Orleans, New Orleans, Louisiana, United States

  • Daniel C. Chelius

    7   Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States

  • Jeffrey C. Rastatter

    8   Division of Pediatric Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
    9   Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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Abstract

Objective

Using multivariate models of social determinants of health (SDoH) featuring census-level Yost Index-socioeconomic status (SES) measures, to determine whether community-level SDoH factors quantifiably influence skull base chordoma–chondrosarcoma disparities more than individual-level SDoH factors on care–prognostic differences nationally.

Design, Setting, Participants

Retrospective cohort, skull base chordomas/chondrosarcoma patients diagnosed between 2010 and 2018 from SEER (Surveillance, Epidemiology, and End Results) were analyzed by multivariate, age-adjusted regressions and Cox proportional hazards models; covariates of sex, race–ethnicity, census-level rurality–urbanicity, census-level Yost-Index score (aggregating 7 SES-measures of education, income, housing).

Main Outcome Measures

Mortality, late-staging, first-line/nonfirst-line treatment, delay-in-treatment.

Results

Across 1,530 skull base chordomas and chondrosarcomas, delay-of-treatment featured a markedly positive independent predictor of minority race/ethnicity (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.27–1.34; p < 0.001). Five-year all-cause mortality showed markedly positive predictors of male-sex (1.82; 1.30–2.56; p < 0.001), minority race/ethnicity (OR, 1.94; 95% CI, 1.32–2.87; p = 0.001), and decreasing Yost-SES (OR, 1.61; 95% CI, 1.14–2.26; p = 0.006). Three-year all-cause mortality featured markedly positive predictors of male-sex (OR, 1.82; 95% CI, 1.30–2.56; p < 0.001) and minority race/ethnicity (OR, 1.75; 95% CI, 1.18–2.58; p = 0.005). Receipt of nonfirst-line radiation therapy showed a markedly positive independent predictor of minority race/ethnicity (OR, 1.34; 95% CI, 1.06–1.71; p = 0.016). Receipt of first-line primary surgery showed a markedly negative independent predictor of decreasing Yost-SES (OR, 0.71; 95% CI, 0.53–0.96; p = 0.024). Advanced-staging showed a markedly positive independent predictor of decreasing Yost-SES (OR, 1.85; 95% CI, 1.19–2.89; p = 0.006).

Conclusion

Through interactional models of individual- and community-level social determinant factors, this study observed detrimental, interrelated SDoH associations with poorer care and prognosis of chordoma and chondrosarcoma patients while quantifiably delineating the strength of factor association with observed disparities.

Keywords

skull base - chordoma - chondrosarcoma - social determinants of health - Yost Index - race–ethnicity - socioeconomic status

Ethical Approval

Per the protocols of Northwestern University's Institutional Review Board (IRB), this study did not require prior IRB/ethics committee approval or waiver of informed consent, as the data consisted of publicly available, deidentified patient data.


* Contributed equally to the work.




Publication History

Received: 23 January 2025

Accepted: 27 April 2025

Article published online:
10 May 2025

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