Effect of Race, Sex, and Socioeconomic Factors on Overall Survival Following the Resection of Intramedullary Spinal Cord Tumors

Introduction: Intramedullary spinal cord tumors (IMSCTs) are rare pathologies that roughly comprise 2-4% of all primary CNS tumors. They are locally invasive and may lead to significant morbidity and functional impairment. This study investigated the association between race and socioeconomic factors with overall 5-year mortality following the resection of IMSCTs.

Methods: The National Cancer Database was utilized to investigate IMSCT resection patients from 2004 to 2017. Patient groups were based on race/ethnicity, facility type, insurance, median income quartiles, and residential area. Secondary outcomes were postoperative length of stay and 30-day readmission, but 5-year survival was the main objective. Significant independent factors related with mortality were identified by descriptive and multivariable analyses, with a 2-sided p < 0.05.

Results: We evaluated the patient characteristics and outcomes for 8,028 patients who underwent surgical treatment for IMSCTs between 2004 and 2017. The majority of patients were white males (52.4%) with a mean age of 44 years where 7.17% of patients were Black, 7.6% were Hispanic, and 3% were Asian. Most were treated in an academic/research program (72.4%) and had private insurance (69.2%). Black patients had a higher odd of 5-year mortality (OR 1.4; 95% CI 1.1 to 1.77; p = 0.04) compared to white patients, while no significant differences in mortality were observed among other races. Factors associated with lower odds of mortality included being female (OR 0.89; 95% CI 0.78 to 1.02; p< 0.01), receiving treatment in an academic/research program (OR 0.51; 95% CI 0.33 to 0.79; p = 0.04), having private insurance (OR 0.65; 95% CI 0.45 to 0.93; p = 0.02), and having higher income quartiles (OR 0.77; 95% CI 0.62 to 0.96; p = 0.02).

Conclusion : Our analysis shows IMSCT surgical management disparities. Black patients, males, those with lower socioeconomic level, and those treated at non-academic centers have higher 5-year mortality rates. Due to these alarming inequalities, policymakers and researchers must address the reasons and provide IMSCT patients with equal access to high-quality surgical care.