Differential Tumor and Socioeconomic Factors Influence Survival in Minority Patients with Meningiomas

Background: Differences in meningioma recurrence and survival outcomes have been described in minority and ethnic populations. Prior studies demonstrate Black patients have worse survival, larger tumors, and lower rates of gross total resection (GTR) in comparison to their White counterparts. Although lower socioeconomic status (SES) has been implicated as a primary driver of these disparities, Latinx patients often demonstrate better health outcomes compared to Black patients despite similar SES. These findings suggest there are other underlying factors in that influence outcome in these populations.

Methods: The NCDB was queried for adult patients with meningiomas from 2012 to 2018. A total of 85,485 patients were included in the study. Patient demographics, tumor characteristics, and overall survival were collected. A Cox proportional hazards model was used to determine contributors to overall survival. A binary logistical regression was used to determine the association between race and factors associated with worse survival.

Results: Compared to White patients, Black patients had a worse overall survival (HR: 1.2; p < 0.0001). Latinx/White (HR: 0.84; p < 0.0001), Latinx/Other (HR: 0.44; p = 0.0097) and Asian race (HR: 0.62; p < 0.0001) had improved overall survival.

Subtotal resection (STR) was associated with worse overall survival (HR: 1.1; p < 0.0001). STR was more likely in Black (HR: 1.18; p < 0.0001), Latinx/White (OR: 1.19; p < 0.0001), Latinx/Black (OR: 1.64; p < 0.0001), and Latinx/Other (OR: 1.16; p = 0.039) compared to White population.

Higher grade meningiomas were more common in Black (OR: 1.24; p < 0.001), Latinx/Black (OR: 1.79; p < 0.0164) and Asian (OR: 1.22; p < 0.0023) populations compared to White populations. Large tumor size (>64 mm) was more common in the Black (OR: 1.14; p = 0.0048), and Asian populations (OR: 1.25; p = 0.0051). There was no association between Latinx/White, Latinx/Black, and Latinx/Other and tumor size.

Black, Latinx, and Asian patients with meningiomas were more likely to live in zip codes with the lowest quartile for no high school diploma (p < 0.0001), while Black and Latinx patients were more likely to live in zip codes with the lowest income quartile (p < 0.0001). Asians were less likely to live in lowest income zip codes (OR: 0.62; p < 0.0001). Black and Latinx patients were less likely to have health insurance coverage (p < 0.0001).

Conclusions: There are differential tumor and socioeconomic factors on survival outcome in minority populations with meningiomas. Black and Latinx/Black populations have a combination of socioeconomic factors and tumor factors, including higher grade tumors, increased tumor size, and STR that contribute to worse outcome. Conversely, Latinx/White, and Latinx/Other populations have better outcomes but are still affected by socioeconomic factors. Although Asian populations tended to have worse tumor characteristics, they tended to have a better overall survival. The findings suggest that while survival outcome is multifactorial, there are likely underlying genetic factors that influence more aggressive tumors in the Black and Asian population and less aggressive tumors in the Latinx population ([Figs. 1]–[4]).

Fig. 1 Forest plot of hazard ratios for patient factors associated with overall survival.

Fig. 2 Bar graph of percent WHO grade meningiomas by race and ethnicity.

Fig. 3 Overall survival by race.

Fig. 4 Differential tumor and socioeconomic factors influencing survival outcome in minority populations.

Publication History

Article published online:
05 February 2024