Socioeconomic Factors Are Associated with Clinical and Radiographic Differences at the Time of Pituitary Adenoma Diagnosis

Introduction: Socioeconomic factors are important metrics that can impact health outcomes. The purpose of our study is to evaluate for meaningful differences among patients with pituitary adenoma at the time of their diagnosis that may be related to their socioeconomic status.

Methods: A single-institution retrospective review of patients with pathology-confirmed pituitary adenoma was performed. Charts were evaluated for demographic, payer, clinical, and radiographic information. To simplify comparisons, payer groups were reduced to Medicare, Medicaid, and private insurance. In this simplified scheme, Medicaid patients constitute a low-income group given state eligibility requirements of income less than 226% of the federal poverty line. Those enrolled in Medicare with a supplemental private insurer were considered Medicare. Data were analyzed using Student’s t-test and Chi-square analysis. This study was conducted with institutional review board approval.

Results: A total of 370 patients were included in this review. The breakdown by insurance was private (44%), Medicare (21%), and Medicaid (35%). Medicaid-insured patients were noted to have greater maximum adenoma diameter (2.89 vs. 2.55 cm; p = 0.025) and larger overall tumor volume (26.2 vs. 15.9 cm³; p = 0.02) at the time of diagnosis compared to privately insured patients. They were also more likely to present with headache compared to private or by Medicare-insured patients (p = 0.01). Privately insured patients were less likely to present with cavernous sinus invasion compared to either Medicaid or Medicare-insured patients (p = 0.007; p = 0.029, respectively). Medicare-insured patients were more likely to have their pituitary adenoma found incidentally than those enrolled in Medicaid (p = 0.0009). Both Black and Hispanic patients had larger maximum tumor diameters compared to White non-Hispanic patients at the time of presentation (2.94 vs. 2.42 cm, p = 0.004; 2.84 vs. 2.42 cm, p = 0.0006, respectively]. Hispanic patients were less likely to have incidentally discovered tumors (p = 0.04) and were specifically more likely to have tumor contacting the optic apparatus and visual deficits at presentation than White non-Hispanic patients (p = 0.04).

Conclusions: Our results suggest clinically significant differences among patients with pituitary adenoma that are associated with socioeconomic factors. Further study is required to determine the reason for these effects and whether they are associated with differences in treatment outcomes.

Publication History

Article published online:
05 February 2024