Characterizing Disparities in Access to Surgery for Pituitary Adenomas: A National Cancer Database Analysis

Area of Science:

• Neurosurgery
• Health Services Research
• Health Equity

Background:

• High-volume facilities (HVFs) offer improved postoperative outcomes for pituitary adenomas (PA).
• Equitable access to these specialized centers remains a significant challenge.
• Understanding disparities in access is critical for improving patient care.

Purpose of the Study:

• To investigate racial and socioeconomic disparities in access to HVFs for PA surgery in the United States.
• To identify factors contributing to unequal distribution of PA patients at HVFs.
• To inform strategies for enhancing equitable access to specialized neurosurgical care.

Main Methods:

• Retrospective analysis of 57,807 adult patients with PA from the National Cancer Database (NCDB), 2004-2019.
• Evaluation of baseline patient characteristics, surgical site, and survival outcomes.
• Multivariable analysis to identify predictors of accessing HVFs for PA resection.

Main Results:

• Nearly half (47.6%) of PA patients underwent surgery at a HVF.
• African-American and Hispanic patients had significantly lower odds of surgery at HVFs.
• Lower income, Medicaid insurance, rural location, and lower educational attainment were associated with reduced HVF access.
• An increasing trend in HVF access for PA patients was observed over time.

Conclusions:

• Significant racial and socioeconomic disparities exist in accessing HVFs for pituitary adenoma surgery.
• These disparities impact equitable distribution of care for PA patients.
• Targeted interventions are needed to address these access barriers and promote health equity.