The Socioeconomic Distressed Communities Index Predicts 90-Day Mortality Among Intracranial Tumor Patients

Sachiv Chakravarti; Cathleen C Kuo; Atharv Oak; Sruthi Ranganathan; Adrian E Jimenez; Foad Kazemi; Max A Saint-Germain; Gary Gallia; Jordina Rincon-Torroella; Christopher Jackson; Chetan Bettegowda; Debraj Mukherjee

doi:10.1016/j.wneu.2024.03.173

The Socioeconomic Distressed Communities Index Predicts 90-Day Mortality Among Intracranial Tumor Patients

World Neurosurg. 2024 Apr 8:S1878-8750(24)00559-X. doi: 10.1016/j.wneu.2024.03.173. Online ahead of print.

Affiliations

¹ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
³ School of Clinical Medicine, University of Cambridge, Cambridge, England.
⁴ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA. Electronic address: dmukher1@jhmi.edu.

PMID: 38599377
DOI: 10.1016/j.wneu.2024.03.173

Abstract

Background: Socioeconomic status (SES) is a major determinant of quality of life and outcomes. However, SES remains difficult to measure comprehensively. Distress communities index (DCI), a composite of 7 socioeconomic factors, has been increasingly recognized for its correlation with poor outcomes. As a result, the objective of the present study is to determine the predictive value of the DCI on outcomes following intracranial tumor surgery.

Methods: A single institution, retrospective review was conducted to identify adult intracranial tumor patients undergoing resection (2016-2021). Patient ZIP codes were matched to DCI and stratified by DCI quartiles (low:0-24.9, low-intermediate:25-49.9, intermediate-high:50-74.9, high:75-100). Univariate followed by multivariate regressions assessed the effects of DCI on postoperative outcomes. Receiver operating curves were generated for significant outcomes.

Results: A total of 2389 patients were included: 1015 patients (42.5%) resided in low distress communities, 689 (28.8%) in low-intermediate distress communities, 445 (18.6%) in intermediate-high distress communities, and 240 (10.0%) in high distress communities. On multivariate analysis, risk of fracture (adjusted odds ratio = 1.60, 95% confidence interval 1.26-2.05, P < 0.001) and 90-day mortality (adjusted odds ratio = 1.58, 95% confidence interval 1.21-2.06, P < 0.001) increased with increasing DCI quartile. Good predictive accuracy was observed for both models, with receiver operating curves of 0.746 (95% CI 0.720-0.766) for fracture and 0.743 (95% CI 0.714-0.772) for 90-day mortality.

Conclusions: Intracranial tumor patients from distressed communities are at increased risk for adverse events and death in the postoperative period. DCI may be a useful, holistic measure of SES that can help risk stratifying patients and should be considered when building healthcare pathways.

Keywords: Intracranial tumor; Mortality; Neuro-oncology; Outcomes; Socioeconomic status.