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Background <p>Prior investigations of the impact of social determinants of health (SDH) on people with primary central nervous system cancers (PCNSC) have considered limited SDH-factors and pathologies. This study examines how the Social Vulnerability Index (SVI) influences disparities in outcome for people with PCNSC across the United States (US).</p> Methods <p>This population-based retrospective cohort study assessed adults with PCNSC between 1975-2017 from the Surveillance-Epidemiology-End Results database, categorized using the Central Brain-Tumor-Registry of the US (CBTRUS) classifications. SDH-vulnerability/SVI scores were assigned to patients’ county-of-residence based on 15 SDH-factors of socioeconomic status (SES), proportions using a minority language (ML), household composition (HC), and infrastructure/housing-transportation (HT) characteristics, plus an overall composite of these four themes. Survival and logistic regressions were obtained for survival period and multimodal treatment receipt across all PCNSC-patients based on their SVI-scores/SDH-vulnerability.</p> Results <p>Across 116,373 PCNSC-patients (64,841 [55.7%] male; 92,476 [79.5%] non-Hispanic white race-ethnicity), increasing overall SDH-vulnerability is associated with relative mean survival period decreases between 22.12%-45.81% across 8/8 CBTRUS-classes, with the largest-magnitude effects among HC, HT, and SES-vulnerabilities. There are decreased odds of external beam radiation for 4/8 CBTRUS-classes (lowest-embryonal: OR, 0.87; 95%CI, 0.80-0.96) and surgery for 3/8 CBTRUS classes (lowest-oligodendroglial: OR 0.96; 95%CI 0.95-0.97). The largest-magnitude effects are among those using ML, followed by impact of HC and HT characteristics.</p> Conclusions <p>SDH-vulnerability associates with worse survival and treatment effects for PCNSC patients. Some specific SDH more strongly influence disparity associations, so resources could be focused more on reducing these disparity drivers.</p>

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Assessments of social vulnerability on central nervous system cancer disparities in the United States

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月10日

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  • David J. Fei-Zhang,
  • Salim C. Lutfallah,
  • Joshua Mensah,
  • Daniel C. Chelius,
  • Michael W. Ruff,
  • Karan Dixit,
  • Jonas Paludo,
  • Stephanie S. Smith,
  • Urjeet A. Patel,
  • Jill N. D’Souza,
  • Jeffrey C. Rastatter,
  • Anthony M. Sheyn

摘要

Background

Prior investigations of the impact of social determinants of health (SDH) on people with primary central nervous system cancers (PCNSC) have considered limited SDH-factors and pathologies. This study examines how the Social Vulnerability Index (SVI) influences disparities in outcome for people with PCNSC across the United States (US).

Methods

This population-based retrospective cohort study assessed adults with PCNSC between 1975-2017 from the Surveillance-Epidemiology-End Results database, categorized using the Central Brain-Tumor-Registry of the US (CBTRUS) classifications. SDH-vulnerability/SVI scores were assigned to patients’ county-of-residence based on 15 SDH-factors of socioeconomic status (SES), proportions using a minority language (ML), household composition (HC), and infrastructure/housing-transportation (HT) characteristics, plus an overall composite of these four themes. Survival and logistic regressions were obtained for survival period and multimodal treatment receipt across all PCNSC-patients based on their SVI-scores/SDH-vulnerability.

Results

Across 116,373 PCNSC-patients (64,841 [55.7%] male; 92,476 [79.5%] non-Hispanic white race-ethnicity), increasing overall SDH-vulnerability is associated with relative mean survival period decreases between 22.12%-45.81% across 8/8 CBTRUS-classes, with the largest-magnitude effects among HC, HT, and SES-vulnerabilities. There are decreased odds of external beam radiation for 4/8 CBTRUS-classes (lowest-embryonal: OR, 0.87; 95%CI, 0.80-0.96) and surgery for 3/8 CBTRUS classes (lowest-oligodendroglial: OR 0.96; 95%CI 0.95-0.97). The largest-magnitude effects are among those using ML, followed by impact of HC and HT characteristics.

Conclusions

SDH-vulnerability associates with worse survival and treatment effects for PCNSC patients. Some specific SDH more strongly influence disparity associations, so resources could be focused more on reducing these disparity drivers.