The Impact of Social Determinants of Health on Vestibular Schwannoma Management: A Single Institution Review

Abstract

Objective: To evaluate social determinants of health and their effect on the management of vestibular schwannoma (VS).

Study design: Retrospective chart review.

Setting: Tertiary referral center.

Patients: Patients >18 years old with sporadic VS newly diagnosed between January 1, 2010, and December 31, 2020.

Interventions: Magnetic resonance imaging; audiogram; treatment recommendations.

Main outcome measures: Differences in treatment recommendations for patients based on their social determinants of health, including race, ethnicity, and socioeconomic status.

Results: A total of 811 patients were included in analysis. Patients with a higher area deprivation index (ADI) presented with larger tumors. A higher ADI was associated with a higher likelihood of recommending radiation (or the option of surgery or radiation) compared with a recommendation of surgery alone. Tumor grade and patient age were significantly associated with treatment recommendation. Older age was associated with a recommendation of observation alone or a recommendation of radiation. Higher tumor grade was associated with a recommendation of surgery. There was a trend for higher hearing class to be associated with a recommendation of surgery, but this did not reach statistical significance. Race, ethnicity, and gender were not significantly associated with treatment recommendation.

Conclusions: Patients with higher levels of disadvantage presented with higher tumor grade, suggesting that access to care influences diagnosis. Factors including age, ADI, and tumor grade were associated with treatment recommendation.