Journal of neuro-oncology · 2026
Individual and community-level associations of social determinants with pituitary adenoma disparities in the US.
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Desai Atharva, Malik Manal, Cook Charles J, Fei-Zhang David J, Puchi Christopher, D'Souza Jill N, Sheyn Anthony M, Talwar Abhinav, Gutierrez Jorge, Chelius Daniel C, Rastatter Jeffrey C, Sethia Rishabh
Аннотация
PURPOSE: Through interactional, multilevel models of social determinants of health (SDoH) incorporating comprehensive census-level and individual-level SDoH-factors, to assess whether pituitary adenoma disparities are more strongly associated with community-level factors compared to individual-level ones.
METHODS: This retrospective study analyzed pituitary adenoma patients nationally between 2010 and 2018 using multivariate, age-adjusted regressions and cox-proportional hazards models; covariates of sex, race-ethnicity, census-level rurality-urbanicity, census-level Yost-Index score (aggregating 7 SES-measures of education, income, housing) and clinical outcomes of mortality, surgical resection, & delays-in-treatment (3 months-or-over from diagnosis).
RESULTS: Across 44,514 pituitary adenomas-patients, all-cause mortality featured markedly positive independent predictors of decreasing Yost-SES (OR, 1.43; 95% CI, 1.35-1.52; p < 0.001) and Male-Sex (OR, 1.24; 95% CI, 1.16-1.32; p < 0.001). Indicated surgery receipt showed markedly positive independent predictors of Male-Sex (OR, 1.64; 95% CI, 1.59-1.72; p < 0.001), Minority Race/Ethnicity (OR, 1.18; 95% CI, 1.14-1.23; p < 0.001), and Rurality (OR, 1.08; 95% CI, 1.01-1.16; p = 0.030). Having a delay-of-treatment showed markedly positive independent predictors of Female-Sex (OR, 1.24; 95% CI, 1.18-1.30; p < 0.001) and decreasing Yost-SES (OR, 1.14; 95% CI, 1.08-1.20; p < 0.001).
CONCLUSIONS: Through assessing individual- and community-level social determinants in tandem, this study identified detrimental SDoH-associations with pituitary adenoma care and prognosis. Community-level Yost-Index SES and individual sex showed stronger associations with observed disparities, presenting multilevel considerations for prospective initiatives to consider.
METHODS: This retrospective study analyzed pituitary adenoma patients nationally between 2010 and 2018 using multivariate, age-adjusted regressions and cox-proportional hazards models; covariates of sex, race-ethnicity, census-level rurality-urbanicity, census-level Yost-Index score (aggregating 7 SES-measures of education, income, housing) and clinical outcomes of mortality, surgical resection, & delays-in-treatment (3 months-or-over from diagnosis).
RESULTS: Across 44,514 pituitary adenomas-patients, all-cause mortality featured markedly positive independent predictors of decreasing Yost-SES (OR, 1.43; 95% CI, 1.35-1.52; p < 0.001) and Male-Sex (OR, 1.24; 95% CI, 1.16-1.32; p < 0.001). Indicated surgery receipt showed markedly positive independent predictors of Male-Sex (OR, 1.64; 95% CI, 1.59-1.72; p < 0.001), Minority Race/Ethnicity (OR, 1.18; 95% CI, 1.14-1.23; p < 0.001), and Rurality (OR, 1.08; 95% CI, 1.01-1.16; p = 0.030). Having a delay-of-treatment showed markedly positive independent predictors of Female-Sex (OR, 1.24; 95% CI, 1.18-1.30; p < 0.001) and decreasing Yost-SES (OR, 1.14; 95% CI, 1.08-1.20; p < 0.001).
CONCLUSIONS: Through assessing individual- and community-level social determinants in tandem, this study identified detrimental SDoH-associations with pituitary adenoma care and prognosis. Community-level Yost-Index SES and individual sex showed stronger associations with observed disparities, presenting multilevel considerations for prospective initiatives to consider.