Individual- and Community-Level Social Determinant Associations With Acoustic Neuroma Disparities in the United States

Abstract

Objective This investigation aims to determine whether community-level social determinants of health (SDoH) influenced acoustic neuroma outcomes more profoundly than individual-level SDoH through the use of multivariate models and census-level socioeconomic status (SES) measures. Study Design Observational, retrospective cohort study. Setting: Specially Authorized Head–Neck SEER 2020 Dataset. Patients 23,330 adult (20+ yr) patients diagnosed with acoustic neuroma from 2010 to 2018. Main outcome measures Age-adjusted multivariate regressions and hazard models were performed for individual level (sex, race–ethnicity) and community-level factors (Yost Index–SES, rurality–urbanicity) to assess for differences in acoustic neuroma treatment, including delay of intervention, treatment receipt, and overall survival. Results Lower Yost–SES/community-level SES had a markedly positive association with an increase in all-cause mortality (HR, 1.55; 95% CI, 1.41–1.71) and negative association with stereotactic radiotherapy treatment (OR, 0.93; 95% CI, 0.86–0.99; p = 0.040). Patients with poor Yost–SES had a significantly positive association with receipt of surgical resection (OR, 1.13; 95% CI, 1.07–1.20; p < 0.001). Conclusions Data generated from this investigation suggest that community-level SDoH, particularly Yost–SES, have more detrimental care and prognostic disparities in acoustic neuroma treatment compared with individual-level factors.