Assessments of social vulnerability on central nervous system cancer disparities in the United States

Prior investigations of the impact of social determinants of health (SDH) on people with primary central nervous system cancers (PCNSC) have considered limited SDH-factors and pathologies. This study examines how the Social Vulnerability Index (SVI) influences disparities in outcome for people with PCNSC across the United States (US). This population-based retrospective cohort study assessed adults with PCNSC between 1975-2017 from the Surveillance-Epidemiology-End Results database, categorized using the Central Brain-Tumor-Registry of the US (CBTRUS) classifications. SDH-vulnerability/SVI scores were assigned to patients’ county-of-residence based on 15 SDH-factors of socioeconomic status (SES), proportions using a minority language (ML), household composition (HC), and infrastructure/housing-transportation (HT) characteristics, plus an overall composite of these four themes. Survival and logistic regressions were obtained for survival period and multimodal treatment receipt across all PCNSC-patients based on their SVI-scores/SDH-vulnerability. Across 116,373 PCNSC-patients (64,841 [55.7%] male; 92,476 [79.5%] non-Hispanic white race-ethnicity), increasing overall SDH-vulnerability is associated with relative mean survival period decreases between 22.12%-45.81% across 8/8 CBTRUS-classes, with the largest-magnitude effects among HC, HT, and SES-vulnerabilities. There are decreased odds of external beam radiation for 4/8 CBTRUS-classes (lowest-embryonal: OR, 0.87; 95%CI, 0.80-0.96) and surgery for 3/8 CBTRUS classes (lowest-oligodendroglial: OR 0.96; 95%CI 0.95-0.97). The largest-magnitude effects are among those using ML, followed by impact of HC and HT characteristics. SDH-vulnerability associates with worse survival and treatment effects for PCNSC patients. Some specific SDH more strongly influence disparity associations, so resources could be focused more on reducing these disparity drivers. Primary central nervous system cancers (PCNSC) are cancers that first occurred in the brain, spinal cord or eyes. Previous studies have identified disparities in access to diagnosis, care and outcome for people with PCNSC in the United States (US) between people with differing incomes, racial-ethnic identity and different levels of health insurance. We considered the impact of these differences and additional factors, such as household characteristics and characteristics of the neighborhood in which people live. We found that a combination of factors worsened outcomes, with some factors having more impact. Our findings highlight objective, actionable disparities that could be targeted to provide the most substantial improvement in outcome for people with PCNSC. Fei-Zhang, Lutfallah et al. assess social vulnerability, care and prognostic outcomes across 116,373 patients diagnosed with central nervous system cancers. Increased overall social vulnerability is associated with substantial decreases in survival period and multimodal treatment receipt.