title: Socioeconomic factors associated with pituitary apoplexy.
abstract: OBJECTIVE
  Pituitary apoplexy is associated with worse outcomes than are pituitary adenomas detected without acute clinical deterioration. The association between pituitary apoplexy and socioeconomic factors that may limit access to health care has not been examined in prior studies.
  
  
  METHODS
  This study involved retrospectively evaluating data obtained in all patients who underwent surgery for nonfunctioning pituitary adenoma causing visual symptoms between January 2003 and July 2012 at the University of California, San Francisco. Patients were grouped into those who presented with apoplexy and those who did not ("no apoplexy"). The 2 groups were compared with respect to annual household income, employment status, health insurance status, and whether or not the patient had a primary health care provider. Associations between categorical variables were analyzed by chi-square test and continuous variables by Student t-test. Multivariate logistic regression was also performed.
  
  
  RESULTS
  One hundred thirty-five patients were identified, 18 of whom presented with apoplexy. There were significantly more unmarried patients and emergency room presentations in the apoplexy group than in the "no apoplexy" group. There was a nonsignificant trend toward lower mean household income in the apoplexy group. Lack of health insurance and lack of a primary health care provider were both highly significantly associated with apoplexy. In a multivariate analysis including marital status, emergency room presentation, income, insurance status, and primary health care provider status as variables, lack of insurance remained associated with apoplexy (OR 11.6; 95% CI 1.9-70.3; p = 0.008).
  
  
  CONCLUSIONS
  The data suggest that patients with limited access to health care may be more likely to present with pituitary apoplexy than those with adequate access.
authors.affiliation: Department of Neurological Surgery and California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Arman
authors.initials: A
authors.lastname: Jahangiri
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Clark
authors.forename: Seunggu J
authors.initials: SJ
authors.lastname: Han
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kunwar
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Blevins
authors.forename: Manish K
authors.initials: MK
authors.lastname: Aghi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000453:epidemiology* / Q000209:etiology; D010911:Pituitary Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D012495:San Francisco / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors; D014786:Vision Disorders / Q000209:etiology; D055815:Young Adult