Socioeconomic and Racial Disparities Affect Access to High-Volume Centers During Meningioma Treatment

Abstract

Studies examining the relationship between hospital case volume, socioeconomic determinants of health, and patient outcomes are lacking. We sought to evaluate these associations in the surgical management of intracranial meningiomas. We queried the National Inpatient Sample (NIS) database for patients who underwent craniotomy for the resection of meningioma in 2013. We categorized hospitals into high (HVC) or low (LVC) volume centers. We compared outcomes in 2016 to assess the potential impact of the Affordable Care Act (ACA) on healthcare equity. Primary outcome measures included hospital mortality, length of stay (LOS), complications, and disposition. A total of 10270 encounters were studied (LVC: n=5730 [55.8%], HVC n=4340 [44.2%]). 62.9% of LVC patients identified as white compared to 70.2% at HVC (p<0.01). A higher percentage of patients at LVC came from the lower two quartiles of median household income than HVC (49.9% vs 44.2% p<0.001). Higher mortality (1.3% vs 0.9% p = 0.041) was in LVCs. Multivariable regression analysis showed LVCs were significantly associated with increased complication (OR 1.36, 95% CI 1.30-1.426, p<0.001) and longer hospital LOS (OR -0.05, 95% CI -0.92,-0.45, p=<0.001). There was a higher proportion of white patients at HVCs in 2016 compared to 2013 (67.9% vs. 72.3%). More patients from top income quartiles (24.2% vs. 40.5%) were treated at HVC in 2016 compared to 2013. This study demonstrated notable racial and socioeconomic disparities in LVC as well as access to HVCs over time. Disparities in meningioma treatment may persistent and require further study.