404 Identification of Persistent Racial Inequities in Recommendations for Resection of Primary Brain Tumors Using a Harmonized Dual Registry Analysis

Abstract

INTRODUCTION: Disparities in outcomes disproportionately affect minority populations in many surgical fields. In contrast, racial disparities in surgical decision-making remains an enigma due to the difficulty in capturing surgeon recommendations during initial patient workup. METHODS: The odds of recommendation against surgical resection at initial diagnosis of primary brain neoplasms was determined using multivariable logistic regression with clinical, demographic, and socioeconomic factors. A dual registry analysis was designed using two national databases (NCDB and SEER), with independent analyses that were harmonized to ensure robustness of conclusions. Adults with the six most common intracranial neoplasms were included in the analysis. RESULTS: Two registries were queried to identify adults with meningioma (n = 63674, n = 222673), glioblastoma (n = 35258, n = 104047), pituitary adenoma (n = 27506, n = 87772), vestibular schwannoma (n = 11525, n = 30745), astrocytoma (n = 5402, n = 10631), and oligodendroglioma (n = 3977, n = 9187) in SEER and NCDB databases, respectively. Multivariable analysis in SEER demonstrated that, independent of clinical, demographic, and socioeconomic factors, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.06-1.21, p < 0.001), glioblastoma (OR 1.14, 95% CI 1.01-1.28, p = 0.038), pituitary adenoma (OR 1.13, 95% CI 1.05-1.22, p < 0.001), and vestibular schwannoma (OR 1.48, 95% CI 1.19-1.84, p < 0.001) when compared to White patients in the SEER dataset. Performing a parallel analysis in NCDB confirmed these results in meningioma (OR 1.26, 95% CI 1.22-1.30, p < 0.001), glioblastoma (OR 1.20, 95% CI 1.13-1.29, p < 0.001), pituitary adenoma (OR 1.26, 95% CI 1.22-1.31), p < 0.001), and vestibular schwannoma (OR 1.30, 95% CI 1.15-1.48, p < 0.001). These findings persisted independent of both patient comorbidities and potential overlap between the databases. CONCLUSIONS: Racial disparities in surgery recommendations for patients with primary brain tumors independent of multiple potential confounders including clinical, demographic, and socioeconomic factors.