Characterizing Racial and Socioeconomic Disparities in Access to Surgery for Pituitary Adenomas at High-Volume Hospitals in the United States: A Retrospective Cohort Analysis from the National Cancer Database

Objective: Surgery is the most common treatment for symptomatic pituitary adenomas (PAs). Although it has been shown that pituitary surgery performed at high-volume facilities (HVFs) are associated with better outcomes, use of such hospitals may not be equitably distributed. In this study, the authors set out to evaluate racial and socioeconomic differences in access to PA surgery at high-volume hospitals in the United States.

Methods: The authors retrospectively queried the National Cancer Database (NCDB) for newly diagnosed PA patients (2004–2019). Greater than 25 pituitary surgeries/year defined an HVF. Patients who received no surgical intervention or those who received surgical intervention at a site other than the reporting facility were excluded. Multivariable logistic regression identified patient-level predictors for undergoing surgery at an HVF and subgroup analyses determined the adjusted odds ratio of the likelihood of undergoing surgery at an HVF during the study period. p-Values < 0.05 were considered statistically significant.

Results: A total of 57,807 patients were included; 47.6% (n = 27,523) underwent surgery at an HVF. On multivariable analysis, Blacks (OR: 0.89, p < 0.001) and Hispanics (OR: 0.80, p < 0.001) had significantly lower odds of undergoing surgery at an HVF (reference = White). Patients from rural locations (OR: 0.79, p = 0.003; reference = urban); with Medicaid insurance (OR: 0.86, p < 0.001; reference = private); lower-income (< $40,227 [OR: 0.93, p = 0.049]; reference ≥ $63,333); and patients from zip codes with large percentages of adults who did not graduate high school (≥ 17.6% [OR: 0.95, p < 0.001]; reference ≤ 6.3%) were significantly less likely to have surgery at an HVF. Subgroup analyses revealed improved odds of undergoing PA surgery at an HVF over time after 2010 (e.g., 2011 [OR: 1.31, p < 0.001]) compared with preceding years (≤ 2010 [OR: ≤ 1.19, p ≥ 0.004]), regardless of sex, Black or Hispanic race/ethnicity, Medicare/other government insurance status, and belonging to the middle or bottom quartiles of average household income and educational attainment (all p < 0.05).

Conclusion: The present analysis from the NCDB revealed significant racial and socioeconomic disparities in access to PA surgery at HVFs. Notwithstanding, there was evidence that these disparities may have improved after 2010 for some underrepresented and disadvantaged groups. Given the national implementation of major healthcare reform during the study period, these findings may assist health policy makers in the development of strategies to ease disparities in access to surgical pituitary care at HVFs for disadvantaged populations (Tables 1–3).

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Artikel online veröffentlicht:
01. Februar 2023