title: The effect of socioeconomic status on gross total resection, radiation therapy and overall survival in patients with gliomas.
abstract: Socioeconomic status (SES) is associated with survival in many cancers but the effect of socioeconomic status on survival and access to care for patients with gliomas has not been well studied. This study included 50,170 patients from the Surveillance, Epidemiology, and End Results Program at the National Cancer Institute database diagnosed with gliomas of the brain from 2003 to 2012. Patient SES was divided into tertiles and quintiles. Treatment options included radiation, surgery (gross total resection (GTR)/other surgery), and radiation with surgery. Multivariable logistic regression and Cox proportional hazards model were used to analyze data with SAS v9.4. The results were adjusted for age at diagnosis, race, sex, tumor type, and tumor grade. Kaplan-Meier survival curves were constructed according to SES tertiles and quintiles. Patients from a higher SES tertile were significantly more likely to receive surgery, radiation, GTR, and radiation with surgery (OR 1.092, 1.116, 1.103, 1.150 respectively, all p < 0.0001). This correlation was also true when patients were divided into quintiles (OR 1.054, 1.072, 1.062, 1.089 respectively, all p < 0.0001). Furthermore, the lowest SES tertiles (HR 1.258, 1.146) and the lowest SES quintiles (HR 1.301, 1.273, 1.194, 1.119) were associated with significantly shorter survival times (all p for trend <0.0001). Surgery, radiation therapy, surgery with radiation therapy, and GTR were also found to be associated with improved overall survival in glioma patients (HR 0.553, 0.849, 0.666, 0.491 respectively, all p < 0.0001). The findings from this national study suggest an effect of SES on access to treatment, and survival in patients with gliomas.
authors.affiliation: Stanford University School of Medicine, 213 Quarry Rd MC5958, Stanford, CA, 94305, USA. sdeb1014@stanford.edu.
authors.forename: Sayantan
authors.identifier: 0000-0003-4151-5636
authors.initials: S
authors.lastname: Deb
authors.affiliation: Stanford University School of Medicine, 213 Quarry Rd MC5958, Stanford, CA, 94305, USA.
authors.forename: Arjun Vivek
authors.initials: AV
authors.lastname: Pendharkar
authors.affiliation: Stanford University School of Medicine, 213 Quarry Rd MC5958, Stanford, CA, 94305, USA.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Schoen
authors.affiliation: Surveillance Research Program, National Cancer Institute, Rockville, MD, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Altekruse
authors.affiliation: Stanford University School of Medicine, 213 Quarry Rd MC5958, Stanford, CA, 94305, USA.
authors.forename: John
authors.initials: J
authors.lastname: Ratliff
authors.affiliation: Stanford University School of Medicine, 213 Quarry Rd MC5958, Stanford, CA, 94305, USA.
authors.forename: Atman
authors.initials: A
authors.lastname: Desai
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D016016:Proportional Hazards Models; D011878:Radiotherapy; D012189:Retrospective Studies; D018426:SEER Program; D012923:Social Class
keywords: Glioma; Gross total resection; Socioeconomic disparities; Survival