title: Socioeconomic status does not affect prognosis in patients with glioblastoma multiforme.
abstract: BACKGROUND
  Glioblastoma multiforme (GBM) is an aggressive malignancy, but there is marked heterogeneity in survival time. Health care disparities have demonstrated significance in oncologic outcomes but have not been clearly examined in this patient population. We investigated the role of sociodemographic variables in the prognosis of adult patients diagnosed with GBM.
  
  
  METHODS
  This retrospective analysis included patients with a histologically confirmed diagnosis of GBM, who underwent resection or biopsy at a single institution from 2000 to 2014. Socioeconomic status (SES) was determined by household income according to the US Census zip code tabulation areas and the US national poverty level. Multivariate Cox proportional hazards analysis calculated effects on patient survival.
  
  
  RESULTS
  Thirty percent of 218 subjects were of low SES, 57% mid, and 13% high. Low SES patients tended to be male (62%), Caucasian (92%), unmarried (91%), have dependents (100%), and limited to high school education (55%). SES did not predict insurance or employment status. SES was associated with marital status and number of cohabitants (P < 0.0001) but not clinical trial enrollment. Multivariate analysis demonstrated no relationship between SES and survival. Shorter prognosis was associated with history of military service (hazard ratio [HR] 2.06, P = 0.0125), elderly patients (HR 1.70, P = 0.0158), and multifocal disease (HR 1.75, P = 0.0119). Longer prognosis was associated with gross total resection (HR 0.49, P = 0.0009), radiation therapy (HR 0.12, P < 0.0001), and temozolomide (HR 0.28, P < 0.0001).
  
  
  CONCLUSIONS
  SES alone does not predict prognosis in patients with newly diagnosed GBM. Sociodemographic variables such as old age, military service record, and insurance type may have a prognostication role.
authors.affiliation: Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Kasl
authors.affiliation: Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Brinson
authors.affiliation: Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Lola B
authors.initials: LB
authors.lastname: Chambless
keywords: Brain tumor; glioblastoma multiforme; glioma; poverty; prognosis; socioeconomic status