The Journal of clinical endocrinology and metabolism · 2025
Characterizing Disparities in Access to Surgery for Pituitary Adenomas: A National Cancer Database Analysis.
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Jimenez Miguel Angel, Horowitz Melanie A, Gendreau Julian L, Yamini Bakhtiar, Ahmed A Karim, Geltzeiler Mathew, Sanusi Olabisi, Wang Eric W, Snyderman Carl H, Choby Garret W, Zenonos Georgios A, Gardner Paul A, Rowan Nicholas R, Mukherjee Debraj
Аннотация
CONTEXT: Although there is an established improved postoperative outcome for pituitary adenomas (PA) surgically resected at high-volume facilities (HVFs), access to these centers may not be equitable.
OBJECTIVE: To investigate the racial and socioeconomic differences that lead to unequal distribution of access for PAs at HVFs in the United States.
DESIGN AND PATIENTS: Retrospective analysis of data from the National Cancer Database from 2004 to 2019 on 57 807 patients with PA.
MAIN OUTCOME MEASURES: Baseline description of patients treated at HVFs, survival outcomes, and predictors of survival were evaluated in patients with PA.
RESULTS: A total of 47.6% (n = 27 523) underwent surgery at a HVF. On multivariable analysis, African-American race [odds ratio (OR): 0.89, P < .001] and Hispanic ethnicity (OR: 0.80, P < .001) had significantly lower odds of having a surgical procedure at a HVF as compared to a reference Caucasian population. Patients from rural locations (OR: 0.79, P = .003; reference = urban); with Medicaid insurance (OR: 0.86, P < .001; reference = private), those with lower income [<$40 227 (OR: 0.93, P = .049); reference = ≥$63 333], and patients from zip codes with large percentages of adults who did not graduate high school [≥17.6% (OR: 0.95, P < .001); reference = <6.3%] were significantly less likely to have surgery at a HVF. An increasing trend in access to surgical care at HVFs for PA patients over time was demonstrated [eg, 2005 (OR = 1.10 [0.97-1.26], P = .173) vs 2019 (OR = 1.27 [1.13-1.43], P < .001)].
CONCLUSION: There are significant racial and socioeconomic disparities in access to HVFs for adult patients seeking surgical resection of pituitary adenomas.
OBJECTIVE: To investigate the racial and socioeconomic differences that lead to unequal distribution of access for PAs at HVFs in the United States.
DESIGN AND PATIENTS: Retrospective analysis of data from the National Cancer Database from 2004 to 2019 on 57 807 patients with PA.
MAIN OUTCOME MEASURES: Baseline description of patients treated at HVFs, survival outcomes, and predictors of survival were evaluated in patients with PA.
RESULTS: A total of 47.6% (n = 27 523) underwent surgery at a HVF. On multivariable analysis, African-American race [odds ratio (OR): 0.89, P < .001] and Hispanic ethnicity (OR: 0.80, P < .001) had significantly lower odds of having a surgical procedure at a HVF as compared to a reference Caucasian population. Patients from rural locations (OR: 0.79, P = .003; reference = urban); with Medicaid insurance (OR: 0.86, P < .001; reference = private), those with lower income [<$40 227 (OR: 0.93, P = .049); reference = ≥$63 333], and patients from zip codes with large percentages of adults who did not graduate high school [≥17.6% (OR: 0.95, P < .001); reference = <6.3%] were significantly less likely to have surgery at a HVF. An increasing trend in access to surgical care at HVFs for PA patients over time was demonstrated [eg, 2005 (OR = 1.10 [0.97-1.26], P = .173) vs 2019 (OR = 1.27 [1.13-1.43], P < .001)].
CONCLUSION: There are significant racial and socioeconomic disparities in access to HVFs for adult patients seeking surgical resection of pituitary adenomas.