Association between socioeconomic status and presenting characteristics and extent of disease in patients with surgically resected nonfunctioning pituitary adenoma

OBJECTIVE: The aim of this study was to evaluate the association between zip code-level socioeconomic status (SES) and presenting characteristics and short-term clinical outcomes in patients with nonfunctioning pituitary adenoma (NFPA).

METHODS: A retrospective review of prospectively collected data from the University of Southern California Pituitary Center was conducted to identify all patients undergoing surgery for pituitary adenoma (PA) from 2000 to 2021 and included all patients with NFPA with recorded zip codes at the time of surgery. A normalized socioeconomic metric by zip code was then constructed using data from the American Community Survey estimates, which was categorized into tertiles. Multiple imputation was used for missing data, and multivariable linear and logistic regression models were constructed to estimate mean differences and multivariable-adjusted odds ratios for the association between zip code-level SES and presenting characteristics and outcomes.

RESULTS: A total of 637 patients were included in the overall analysis. Compared with patients in the lowest SES tertile, those in the highest tertile were more likely to be treated at a private (rather than safety net) hospital, and were less likely to present with headache, vision loss, and apoplexy. After multivariable adjustment for age, sex, and prior surgery, SES in the highest compared with lowest tertile was inversely associated with tumor size at diagnosis (-4.9 mm, 95% CI -7.2 to -2.6 mm, p < 0.001) and was positively associated with incidental diagnosis (multivariable-adjusted OR 1.72, 95% CI 1.02-2.91). Adjustment for hospital (private vs safety net) attenuated the observed associations, but disparities by SES remained statistically significant for tumor size. Despite substantial differences at presentation, there were no significant differences in length of stay or odds of an uncomplicated procedure by zip code-level SES. Patients from lower-SES zip codes were more likely to require postoperative steroid replacement and less likely to achieve gross-total resection.

CONCLUSIONS: In this series, lower zip code-level SES was associated with more severe disease at the time of diagnosis for NFPA patients, including larger tumor size and lower rates of incidental diagnosis. Despite these differences at presentation, no significant differences were observed in short-term postoperative complications, although patients with higher zip code-level SES had higher rates of gross-total resection.

Medienart:	E-Artikel

Erscheinungsjahr:	2022
Erschienen:	2022

Enthalten in:	Zur Gesamtaufnahme - volume:137
Enthalten in:	Journal of neurosurgery - 137(2022), 6 vom: 01. Dez., Seite 1699-1706

Sprache:	Englisch

Beteiligte Personen:	Cote, David J [VerfasserIn] Ruzevick, Jacob J [VerfasserIn] Kang, Keiko M [VerfasserIn] Pangal, Dhiraj J [VerfasserIn] Bove, Ilaria [VerfasserIn] Carmichael, John D [VerfasserIn] Shiroishi, Mark S [VerfasserIn] Strickland, Ben A [VerfasserIn] Zada, Gabriel [VerfasserIn]

Links:	Volltext

Themen:	Apoplexy Journal Article Pituitary adenoma Pituitary surgery Socioeconomic status Tumor size Zip code

Anmerkungen:	Date Completed 05.12.2022 Date Revised 05.12.2022 published: Electronic-Print Citation Status MEDLINE

doi:	10.3171/2022.2.JNS212673

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PPN (Katalog-ID):	NLM339253029