Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Kansas City University School of Osteopathic Medicine, Kansas City, MO, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA.
Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA.
Cancer Epidemiol. 2024 Dec;93:102657. doi: 10.1016/j.canep.2024.102657. Epub 2024 Sep 6.
Non-malignant primary tumors of the spine (NMPTS) patients in rural areas face unique barriers that may limit their capacity to receive optimal care. With a lower geographical distribution of neurosurgical specialists and limited healthcare infrastructure, rural NMPTS patients may receive certain treatments at a lower frequency than metropolitan patients. NMPTS We sought to examine the association between residential urbanicity, race-ethnicity, treatment patterns, and survival outcomes for cases diagnosed with NMPTS.
Cases of NMPTS diagnosed between 2004 and 2019 were identified from the Central Brain Tumor Registry of the United States (CBTRUS), a combined dataset of CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology and End Results (SEER) data. Using multivariable logistic regression, we evaluated the association between urbanicity and treatment (including surgery and radiation), adjusted for age at diagnosis, sex, and race-ethnicity. Patient-level all-cause survival data were obtained from the NPCR Survival Analytical Database (2004-2018).
A total of 38,414 cases were identified, 33,097 of whom lived in metropolitan and 5317 of whom lived in non-metropolitan regions. Nerve sheath tumors and meningiomas were the most common tumor histopathologies across both regions, with no clinically significant difference in other histopathologies (p<0.001). There were statistically significant differences between the frequency and type of surgery received by urbanicity (p<0.001). Overall all-cause survival was significantly lower for NH Blacks residing in non-metropolitan areas when compared to NH Blacks residing in metropolitan areas (p<0.0001).
Our data demonstrates significant differences in the incidence of NMPTS across both race-ethnicity and urbanicity. However, a wider analysis of all-cause mortality reveals disparities in health outcomes across both race-ethnicity and urbanicity for Black and Hispanic populations. To address the disparity in health outcomes, policymakers and health providers need to work with local communities in rural areas to improve access to equitable and quality healthcare.
农村地区的非恶性脊柱原发性肿瘤（NMPTS）患者面临着独特的障碍，这可能限制他们获得最佳治疗的能力。由于神经外科专家的地理分布较低，医疗保健基础设施有限，农村 NMPTS 患者接受某些治疗的频率可能低于城市患者。我们旨在研究居住的城市化程度、种族、治疗模式与诊断为 NMPTS 患者的生存结果之间的关联。
在美国中央脑肿瘤登记处（CBTRUS）中，从 2004 年至 2019 年期间，确定了 NMPTS 病例，该登记处是疾病预防控制中心国家癌症登记处（NPCR）和 NCI 的监测、流行病学和最终结果（SEER）数据的组合数据集。使用多变量逻辑回归，我们评估了城市化程度与治疗（包括手术和放疗）之间的关联，调整了诊断时的年龄、性别和种族。从 NPCR 生存分析数据库（2004-2018 年）获得了患者水平的全因生存数据。
共确定了 38414 例病例，其中 33097 例生活在大都市地区，5317 例生活在非大都市地区。神经鞘瘤和脑膜瘤是两个地区最常见的肿瘤组织病理学类型，其他组织病理学类型无明显差异（p<0.001）。城市化程度与手术的频率和类型之间存在统计学上的显著差异（p<0.001）。与生活在大都市地区的非西班牙裔黑人相比，生活在非大都市地区的非西班牙裔黑人的总体全因生存率明显较低（p<0.0001）。
我们的数据表明，非恶性脊柱原发性肿瘤的发病率在种族和城市化程度上存在显著差异。然而，对全因死亡率的更广泛分析表明，黑人和西班牙裔人口在种族和城市化程度上的健康结果存在差异。为了解决健康结果的差异，政策制定者和医疗保健提供者需要与农村地区的当地社区合作，改善获得公平和高质量医疗保健的机会。
