A Harmonized Dual-Registry Analysis Identifies Racial Inequity in Surgeon Recommendations for Resection of Skull Base Tumors

Introduction: Disparities in healthcare may affect patients that differ by age, gender, race, ethnicity, and insurance status among other characteristics. Disparity research is often focused on how patient factors (e.g., insurance status) or institution-specific (e.g., size/volume at institution) factors contribute to differential outcomes; however, little is known about provider-specific (e.g., a surgeon's recommendation) effects disparities in healthcare delivery. Provider-specific effects are difficult to study due to challenges in capturing surgeon recommendations during initial patient workup.

Objective: To identify the impact of socioeconomic factors on initial surgical decision-making of newly diagnosed primary skull base tumors.

Methods: The main outcome measure was the odds of recommendation against surgical resection at time of initial diagnosis. We captured the odds of recommendation against surgical resection at initial diagnosis of intracranial tumors using a dual registry approach incorporating parallel analyses from both the SEER and NCDB national databases for internal validation. We used multivariable logistic regression including clinical, demographic, and socioeconomic factors in both databases in parallel to enhance internal validation and to ensure robustness of our conclusions. Adults with the three most common skull base neoplasms (meningioma, pituitary adenoma, vestibular schwannoma) were included in the analysis.

Results: Two registries were queried to identify adults with meningioma (n = 63,674, n = 222,673), pituitary adenoma (n = 27,506, n = 87,772), and vestibular schwannoma (n = 11,525, n = 30,745) in SEER and NCDB databases, respectively. Multivariable analysis in SEER demonstrated that, independent of clinical, demographic, and socioeconomic factors, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (odds ratio [OR]: 1.13, p < 0.001), pituitary adenoma (OR: 1.13, p < 0.001), and vestibular schwannoma (OR: 1.48, p < 0.001) when compared with White patients in the SEER dataset. Performing a parallel analysis in NCDB confirmed these results in meningioma (OR: 1.26, p < 0.001), pituitary adenoma (OR: 1.26, p < 0.001), and vestibular schwannoma (OR: 1.30, p < 0.001). These findings persisted independent of both patient comorbidities and potential overlap between the databases ([Figs. 1] [2] [3]).

Conclusion: Racial disparities in surgery recommendations for patients with primary skull base tumors independent of multiple potential confounders including clinical, demographic, and socioeconomic factors.

Figure 1 Odds of recommendation against surgery for the four most prevalent intracranial tumor diagnoses in the SEER database.

Figure 2 Odds of recommendation against surgery for the five most prevalent intracranial tumor diagnoses in the NCDB database.

Figure 3 Odds of recommendation against surgical resection for Black patients after including clinical, demographic, and socioeconomic status in multivariable analysis.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
01 February 2023