Cone Pevehouse Young Neurosurgeon Award: The Impact of Socioeconomic Status on Short-term and Long-term Outcomes Following Surgery for Malignant Brain Neoplasms: A Propensity Score-Matched Analysis

Introduction: Malignant neoplasms of the brain include cancers of the central nervous system, including malignancies of the meninges, cerebrum, cerebellum, and brain stem. While socioeconomic status (SES) is known to affect health outcomes, its specific impact on post-surgical outcomes in patients with malignant brain neoplasms remains poorly characterized.

Methods: This propensity score-matched study was carried out using the TriNetX Analytics Network with deidentified patient data from 68 healthcare organizations. Patients included were aged 18 and older with a diagnosis of malignant brain neoplasms and subsequent brain surgery. After matching for common comorbidities, 1998 patients (low SES: 999 patients, high SES: 999 patients) were included.

Results: One year follow-up showed marginally higher recurrence rate in the low SES group (76.5% vs 72.9%; p=0.064). Similarly, one-year mortality showed a trend toward higher risk in the low SES group (81.8% vs 78.9%; p=0.103). Survival analyses revealed significantly shorter median time to recurrence and mortality (p=0.001) in the low SES group, with hazard ratios indicating approximately 18-19% higher risk of events (recurrence HR: 1.189, mortality HR: 1.182).
In the full follow-up analysis, while absolute risks of recurrence (low SES: 78.7% vs high SES: 77.7%; p=0.588) and mortality (low SES: 85.0% vs high SES: 86.1%; p=0.484) were similar, survival analyses revealed significant differences. Low SES patients showed 16-17% higher risk of events over time (recurrence HR: 1.173, mortality HR: 1.161).

Conclusion : This study demonstrates that low SES patients showed consistently higher risk of adverse outcomes in time-to-event analyses, particularly in the first year after surgery. These findings highlight the need for targeted interventions to improve early post-surgical outcomes and follow-up care in low SES patients with malignant brain neoplasms.