Social determinants of health and the prediction of 90-day mortality among brain tumor patients

Adrian E Jimenez; Kyle V Cicalese; Sachiv Chakravarti; Jose L Porras; Tej D Azad; Christopher M Jackson; Gary L Gallia; Chetan Bettegowda; Jon Weingart; Debraj Mukherjee

doi:10.3171/2022.1.JNS212829

Social determinants of health and the prediction of 90-day mortality among brain tumor patients

J Neurosurg. 2022 Mar 11;137(5):1338-1346. doi: 10.3171/2022.1.JNS212829. Print 2022 Nov 1.

Affiliations

¹ 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
² 2Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

PMID: 35353473
DOI: 10.3171/2022.1.JNS212829

Abstract

Objective: Within the neurosurgical oncology literature, the effect of structural and socioeconomic factors on postoperative outcomes remains unclear. In this study, the authors quantified the effects of social determinant of health (SDOH) disparities on hospital complications, length of stay (LOS), nonroutine discharge, 90-day readmission, and 90-day mortality following brain tumor surgery.

Methods: The authors retrospectively reviewed the records of brain tumor patients who had undergone resection at a single institution in 2017-2019. The prevalence of SDOH disparities among patients was tracked using International Classification of Diseases Ninth and Tenth Revisions (ICD-9 and ICD-10) codes. Bivariate (Mann-Whitney U-test and Fisher's exact test) and multivariate (logistic and linear) regressions revealed whether there was an independent relationship between SDOH status and postoperative outcomes.

Results: The patient cohort included 2519 patients (mean age 55.27 ± 15.14 years), 187 (7.4%) of whom experienced at least one SDOH disparity. Patients who experienced an SDOH disparity were significantly more likely to be female (OR 1.36, p = 0.048), Black (OR 1.91, p < 0.001), and unmarried (OR 1.55, p = 0.0049). Patients who experienced SDOH disparities also had significantly higher 5-item modified frailty index (mFI-5) scores (p < 0.001) and American Society of Anesthesiologists (ASA) classes (p = 0.0012). Experiencing an SDOH disparity was associated with a significantly longer hospital LOS (p = 0.0036), greater odds of a nonroutine discharge (OR 1.64, p = 0.0092), and greater odds of 90-day mortality (OR 2.82, p = 0.0016) in the bivariate analysis. When controlling for patient demographics, tumor diagnosis, mFI-5 score, ASA class, surgery number, and SDOH status, SDOHs independently predicted hospital LOS (coefficient = 1.22, p = 0.016) and increased odds of 90-day mortality (OR 2.12, p = 0.028).

Conclusions: SDOH disparities independently predicted a prolonged hospital LOS and 90-day mortality in brain tumor patients. Working to address these disparities offers a new avenue through which to reduce patient morbidity and mortality following brain tumor surgery.

Keywords: brain tumor; mortality; neuro-oncology; oncology; outcomes.