New methods to assess trends in neuro-oncological care

Abstract

To the Editors: We read with great interest the topical review article by Curry and Barker [1]. The authors wonderfully summarized more than a decade of work in the literature, highlighting racial, ethnic, and socioeconomic disparities in the incidence, pathobiology, and outcomes of brain tumor patients. We would like to add a few salient points to this important discussion. As we begin to mark the 10-year anniversary of the era which brought us the landmark reports To Err Is Human and Crossing the Quality Chasm, clinicians and scholars across the nation continue to seek novel approaches to providing improved access to high-quality healthcare by reducing disparities [2, 3]. The last decade has seen a dizzying rise in technological innovation and specialization. However, despite the growth of centers of excellence with state-of-the-art diagnostic and therapeutic capabilities for patients with brain tumors, one is left to wonder whether the quality chasm has truly narrowed despite an ever growing separation between our fields’ newest clinical advances and our society’s most neglected members. It is at this crucial moment in time, as the nationwide call for healthcare reform has again seemingly reached a precipice, that we reexamine potential areas of improvement within our current health care system. As neurosurgeons and health systems researchers, we found the statement by Curry and Barker that ‘‘the complex interaction between race and socioeconomic status is not addressed (in previous work) because SEER public use tapes do not contain individual socioeconomic information’’ particularly interesting [1]. While the Surveillance, Epidemiology, and End Results (SEER) database, as well as the Nationwide Inpatient Sample (NIS) and other databases, does lack some important covariates of interest involving patients and their environments, such as patient immigration status or neurosurgeon density in the communities within which patients live, we have found that linkage of databases via constants contained in both databases of choice may allow for the investigation of novel hypotheses [4, 5]. For instance, the SEER and NIS may separately be linked to the Area Resource File (ARF), a database containing a plethora of socioeconomic characteristics for each zip code within the United States, to gather new insight into environmental, pre-hospital determinants of access to care [6]. As with any methodology, however, this linkage does have weaknesses. For instance, ARF data provides socioeconomic covariates at the county level, not directly down to the patient level. Nevertheless, this novel linkage does help the researcher gain some new insight into variables of interest and may help lay a foundation for the development of more nuanced, future prospective studies. The Johns Hopkins Neuro-Oncological Surgery Outcomes Group has used this novel method of database linkage to move beyond the descriptive data often generated from studies utilizing national administrative resources. Through a series of upcoming papers utilizing this D. Mukherjee A. Quinones-Hinojosa (&) Department of Neurosurgery and Oncology, Neuro-Oncology Surgical Outcomes Research Laboratory, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD 21231, USA e-mail: aquinon2@jhmi.edu