Associations between urbanicity and spinal cord astrocytoma management and outcomes

David A W Sykes; Romaric Waguia; Nancy Abu-Bonsrah; Mackenzie Price; Tara Dalton; Jacob Sperber; Edwin Owolo; Harrison Hockenberry; Brandon Bishop; Carol Kruchko; Jill S Barnholtz-Sloan; Melissa Erickson; Quinn T Ostrom; C Rory Goodwin

doi:10.1016/j.canep.2023.102431

Associations between urbanicity and spinal cord astrocytoma management and outcomes

Cancer Epidemiol. 2023 Oct:86:102431. doi: 10.1016/j.canep.2023.102431. Epub 2023 Jul 19.

Affiliations

¹ Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA.
² Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Central Brain Tumor Registry of the United States, Hinsdale, IL, USA.
⁴ Central Brain Tumor Registry of the United States, Hinsdale, IL, USA.
⁵ Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA; Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, MD, USA.
⁶ Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
⁷ Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
⁸ Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA. Electronic address: rory.goodwin@duke.edu.

PMID: 37478632
DOI: 10.1016/j.canep.2023.102431

Abstract

Background: The management of spinal cord astrocytomas (SCAs) remains controversial and may include any combination of surgery, radiation, and chemotherapy. Factors such as urbanicity (metropolitan versus non-metropolitan residence) are shown to be associated with patterns of treatment and clinical outcomes in a variety of cancers, but the role urbanicity plays in SCA treatment remains unknown.

Methods: The Central Brain Tumor Registry of the United States (CBTRUS) analytic dataset, which combines data from CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results Programs, was used to identify individuals with SCAs between 2004 and 2019. Individuals' county of residence was classified as metropolitan or non-metropolitan. Multivariable logistic regression models were used to evaluate associations between urbanicity and SCA. Cox proportional hazard models were constructed to assess the effect of urbanicity on survival using the NPCR survival dataset (2004-2018).

Results: 1697 metropolitan and 268 non-metropolitan SCA cases were identified. The cohorts did not differ in age or gender composition. The populations had different racial/ethnic compositions, with a higher White non-Hispanic population in the non-metropolitan cohort (86 % vs 66 %, p < 0.001) and a greater Black non-Hispanic population in the metropolitan cohort (14 % vs 9.9 %, p < 0.001). There were no significant differences in likelihood of receiving comprehensive treatment (OR=0.99, 95 % CI [0.56, 1.65], p = >0.9), or survival (hazard ratio [HR]=0.92, p = 0.4) when non-metropolitan and metropolitan cases were compared. In the metropolitan cohort, there were statistically significant differences in SCA treatment patterns when stratified by race/ethnicity (p = 0.002).

Conclusions: Urbanicity does not significantly impact SCA management or survival. Race/ethnicity may be associated with likelihood of receiving certain SCA treatments in metropolitan communities.

Keywords: Central brain tumor registry; Race/ethnicity; Radiation; Social determinants of health; Spinal cord astrocytoma; Surgery; Survival; Urbanicity.