341 Racial Disparities in Incidence, Treatment, and Survival in Adult Brain Metastases: A 10-Year National Database Analysis

Abstract

INTRODUCTION: Brain metastases are the most common central nervous system tumors in the United States. It is imperative to understand how prognosis and survival varies demographically to ensure equitable care for vulnerable populations and reduce financial burdens on the healthcare system. METHODS: Using the Surveillance, Epidemiology, and End Result Program (SEER) database, adults with non-primary brain metastases between 2010 and 2019 were identified. The primary outcome measure was all-cause mortality within 5 years. Chi-squared tests of independence and one way analyses of variance were used to compare group differences between White, Black, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native patients. A Cox proportional hazards model was developed to evaluate the risk of death within 5 years. RESULTS: A total of 65,154 patient records were identified following exclusion based on age (>84 years or <18 years), missing race data, and missing survival data. The incidence of brain metastases increased from 2.53 per 100,000 adults in 2010 to 2.71 per 100,000 in 2019. A/PI patients had the highest population-adjusted incidence, highest population proportion of high income, the longest time from diagnosis to treatment, lowest rate of radiation refusal, and highest rate of chemotherapy treatment. Subsequently, A/PI patients had the highest 5-year survival rate compared to White and Black patients (9.05% vs. 4.15% vs. 3.23% respectively, p < 0.001). Chemotherapy (OR = 0.44) and surgery (OR = 0.51) were the strongest protective factors against death while being widowed (OR = 1.15) and having primary lung cancer (OR = 1.14) strongest risk factors. CONCLUSIONS: A/PI patients also have a significant survival advantage compared to White, Black, and AI/AN patients, potentially due to higher rates of radiation and chemotherapy treatment. Patients of other races are recommended treatment at lower rates than A/PI patients, suggesting a discrepancy in services offered to these patients.