The Relationship Between Social Vulnerability Index, Surveillance Imaging and Clinical Outcomes After Surgical Resection of Pituitary Tumors

Introduction: Socioeconomic status, race, and ethnicity have been found to influence patient outcomes for various cancer subtypes, including brain tumors. In particular, patients who identify as Black or Hispanic in socioeconomically disadvantaged communities have been reported to present with more advanced disease and experience decreased survival. The aim of this study was to analyze the association between socioeconomic variables, ethnicity, rates of post-surgical follow-up, and clinical outcomes after pituitary tumor resection.

Methods: A retrospective review was completed for patients with pituitary adenomas who underwent surgical resection between 2018-2021. Patient demographics and information related to post-operative appointments and MRIs were obtained. Social vulnerability index (SVI) scores were recorded from the Centers for Disease Control based on nationwide census tracts. SVI scores < 0.50 were categorized as low/low-moderate and SVI >0.50 as moderate-high/high.

Results: Seventy-three patients were included in the analysis (41 males). Mean age was 54.6±16.7 years. In this cohort, 51% were Black, 33% Hispanic, 8% White, 1% Asian, and 36% Other. Mean overall SVI score was 0.80±0.25, with 63 patients having an SVI >0.50. The number of cancelled appointments was significantly higher in the moderate-high/high SVI group (p=0.042). Additionally, 30% of patients with moderate-high/high SVI had ≥2 cancelled follow-up visits compared to 0% among patients with low/low-moderate SVI (p=0.044).

Conclusion : Patients with pituitary tumors requiring surgery and high social vulnerability have increased rates of cancelled follow-up visits compared to patients with low SVI. Delay in follow-up can lead to failed identification of tumor recurrence and more advanced disease by the time medical care is re-initiated. Additionally, lack of prompt treatment of post-operative complications can also lead to poorer outcomes. Healthcare disparities are particularly prevalent among patients from lower socioeconomic backgrounds, and can lead to increased rates of morbidity and mortality. Further work is needed to address and bridge these care gaps.