Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.
Childs Nerv Syst. 2024 Jan;40(1):79-86. doi: 10.1007/s00381-023-06098-6. Epub 2023 Aug 7.
Although social determinants of health (SDOH) have been associated with adverse surgical outcomes, cumulative effects of multiple SDOH have never been studied. The area deprivation index (ADI) assesses cumulative impact of SDOH factors on outcomes. We analyzed the relationship between ADI percentile and postoperative outcomes in pediatric patients diagnosed with brain tumors.
A retrospective, observational study was conducted on our consecutive series of pediatric brain tumor patients presenting between January 1, 1999, and May 31, 2022. Demographics and outcomes were collected, identifying SDOH factors influencing outcomes found in the literature. ADI percentiles were identified based on patient addresses, and patients were stratified into more (ADI 0-72%) and less (ADI 73-100%) disadvantaged cohorts. Univariate and multivariate logistic regression analyses were completed for demographics and outcomes.
A total of 272 patients were included. Demographics occurring frequently in the more disadvantaged group were Black race (13.1% vs. 2.8%; P = .003), public insurance (51.5% vs. 27.5%; P < .001), lower median household income ($64,689 ± $19,254 vs. $46,976 ± $13,751; P < .001), and higher WHO grade lesions (15[11.5%] grade III and 8[6.2%] grade IV vs. 8[5.6%] grade III and 5[3.5%] grade IV; P = .11). The more disadvantaged group required adjunctive chemotherapy (25.4% vs. 12.05%; P = .007) or radiation therapy (23.9% vs. 12.7%; P = .03) more frequently and had significantly greater odds of needing adjunctive chemotherapy (odds ratio [OR], 1.11; confidence interval [CI], 1.01-1.22; P = .03) in a multivariate model, which also identified higher WHO tumor grades at presentation (OR, 1.20; CI, 1.14-1.27; P < .001).
These findings are promising for use of ADI to represent potential SDOH disadvantages that pediatric patients may face throughout treatment. Future studies should pursue large multicenter collaborations to validate these findings.
尽管社会决定因素（SDOH）与不良手术结果相关，但尚未研究多个 SDOH 的累积效应。区域剥夺指数（ADI）评估 SDOH 因素对结果的累积影响。我们分析了 ADI 百分位数与儿童脑瘤患者术后结果之间的关系。
对 1999 年 1 月 1 日至 2022 年 5 月 31 日期间连续就诊的儿童脑瘤患者进行回顾性、观察性研究。收集人口统计学和结果数据，确定文献中发现的影响结果的 SDOH 因素。根据患者的地址确定 ADI 百分位数，并将患者分为劣势较大（ADI 0-72%）和劣势较小（ADI 73-100%）的两组。对人口统计学和结果进行单变量和多变量逻辑回归分析。
共纳入 272 例患者。劣势较大组中经常出现的人口统计学特征为黑种人（13.1%比 2.8%；P = .003）、公共保险（51.5%比 27.5%；P < .001）、较低的中位家庭收入（$64689 ± $19254 比 $46976 ± $13751；P < .001）和更高的世界卫生组织（WHO）分级病变（15[11.5%]级 3 级和 8[6.2%]级 4 级比 8[5.6%]级 3 级和 5[3.5%]级 4 级；P = .11）。劣势较大组更需要辅助化疗（25.4%比 12.05%；P = .007）或放疗（23.9%比 12.7%；P = .03），并且在多变量模型中更有可能需要辅助化疗（优势比 [OR]，1.11；置信区间 [CI]，1.01-1.22；P = .03），该模型还确定了更高的 WHO 肿瘤分级（OR，1.20；CI，1.14-1.27；P < .001）。
这些发现为使用 ADI 来代表儿科患者在治疗过程中可能面临的潜在 SDOH 劣势提供了希望。未来的研究应该寻求大型多中心合作来验证这些发现。
