Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis

• Published in: The Lancet (British edition) 2022-12, Vol.400 (10368), p.2063-2073
• Main Authors: Butterfield, John T, Golzarian, Sina, Johnson, Reid, Fellows, Emily, Dhawan, Sanjay, Chen, Clark C, Marcotte, Erin L, Venteicher, Andrew S
• Format: Article
• Language: English
• Subjects: Adenoma; Adult; Adults; Astrocytoma; Brain; Brain cancer; Brain surgery; Brain tumors; Clinical decision making; Cohort analysis; Cohort Studies; Comorbidity; Datasets; Demographics; Demography; Diagnosis; Epidemiology; Glioblastoma; Glioblastoma - epidemiology; Glioblastoma - surgery; Health disparities; Healthcare Disparities; Humans; Meningioma; Minority & ethnic groups; Mortality; Neoplasms; Neuroma, Acoustic; Oligodendroglioma; Patients; Pituitary; Pituitary Neoplasms; Race; Race factors; Racial discrimination; Schwann cells; Social factors; Socioeconomic factors; Socioeconomics; Surgeons; Tumors; Vestibular system; White People
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(22)00839-X

Disparities in treatment and outcomes disproportionately affect minority ethnic and racial populations in many surgical fields. Although substantial research in racial disparities has focused on outcomes, little is known about how surgeon recommendations can be influenced by patient race. The aim of this study was to investigate racial and socioeconomic disparities in the surgical management of primary brain tumors. In this registry-based cohort study, we used data from the Surveillance, Epidemiology, and End Results (SEER) database (1975–2016) and the American College of Surgeons National Cancer Database (NCDB) in the USA for independent analysis. Adults (aged ≥20 years) with a new diagnosis of meningioma, glioblastoma, pituitary adenoma, vestibular schwannoma, astrocytoma, and oligodendroglioma, with information on tumour size and surgical recommendation were included in the analysis. The primary outcome of this study was the odds of a surgeon recommending against surgical resection at diagnosis of primary brain neoplasms. This outcome was determined using multivariable logistic regression with clinical, demographic, and socioeconomic factors. This study included US national data from the SEER (1975–2016) and NCDB (2004–17) databases of adults with a new diagnosis of meningioma (SEER n=63 674; NCDB n=222 673), glioblastoma (n=35 258; n=104 047), pituitary adenoma (n=27 506; n=87 772), vestibular schwannoma (n=11 525; n=30 745), astrocytoma (n=5402; n=10 631), and oligodendroglioma (n=3977; n=9187). Independent of clinical and demographic factors, including insurance status and rural–urban continuum code, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (adjusted odds ratio 1·13, 95% CI 1·06–1·21, p