Analysis of Demographic and Socioeconomic Disparities in Pituitary Adenoma Surgery: A National Database Cohort

Background: The management of pituitary adenomas encompasses a spectrum of strategies, yet how these strategies are applied between populations is poorly understood. A critical knowledge gap exists in determining whether variations in the application of medical observation, medical therapy, or surgery reflect differing clinical indications or instead underlying sociodemographic disparities. While sociodemographic disparities are documented in other neurosurgical domains, a large-scale analysis of how sex, race, and age influence the entire surgical care cascade is conspicuously absent for pituitary adenomas. This study leverages a national database to systematically investigate these potential inequities. Methods: This retrospective cohort study leveraged the TriNetX Research Network to identify adults diagnosed with pituitary adenomas from 2011-2024. We assessed the impact of sex, race, and age on the primary outcome of receiving medical vs. surgical intervention. Secondary analysis included surgical technique utilized (craniotomy, endoscopic vs. microscopic) and panel of outcomes defined by the Pituitary Surgery Outcomes and Priorities Delphi consensus. To quantify disparities, multivariable logistic regression models were constructed to calculate adjusted odds ratios (aORs) with 95% confidence intervals. All models were rigorously adjusted to isolate the independent effects of the demographic variables of interest on the entire surgical care cascade. Results: Among 127,013 patients with pituitary adenomas, 52.8% were female. However, only 28.7% of the 12,193 surgical patients were female. Females were younger at diagnosis and had higher rates of obesity, hyperprolactinemia, hypothyroidism, and fatigue. Males had higher rates of cardiovascular comorbidities, visual disturbances, and blindness. After adjusting for these baseline characteristics, Female sex was independently associated with lower odds of surgery (aOR 0.62, 95% CI 0.59–0.65; p