Rural Disadvantage in Glioblastoma Concentrates in the Early Postoperative Period: A Single-Center, Treatment-Standardized Cohort Study

Abstract Background Glioblastoma (GB) is the most common and most aggressive malignant primary brain tumor, with 5-year survival rates around 5%. While treatment-related factors significantly impact outcomes, the influence of sociodemographic variables remains unclear, with prior studies showing inconsistent findings. These inconsistencies may stem from underrepresentation of rural patients within national databases and from comparison across centers with variable treatment practices. Objective To evaluate whether population size, geographic distance, and regional-average income influence short- and long-term survival among GB patients when treatment delivery is uniform. Methods We analyzed 248 patients who underwent surgical resection at a single publicly funded tertiary neurosurgical center serving all of Southeastern Ontario (2017-2023). Multivariable logistic regression assessed 90-day mortality, while Cox proportional hazards models with time-varying treatment covariates evaluated overall survival (OS). Results Among 248 patients, 71.8% resided in communities with