The Impact of Social Determinants of Health on Vestibular Schwannoma Management: A Single Institution Review.

ABSTRACT

OBJECTIVE: To evaluate social determinants of health and their effect on the management of vestibular schwannoma (VS). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS Patients >18 years old with sporadic VS newly diagnosed between January 1, 2010, and December 31, 2020. INTERVENTIONS: Magnetic resonance imaging; audiogram; treatment recommendations. MAIN OUTCOME MEASURES: Differences in treatment recommendations for patients based on their social determinants of health, including race, ethnicity, and socioeconomic status. RESULTS: A total of 811 patients were included in analysis. Patients with a higher area deprivation index (ADI) presented with larger tumors. A higher ADI was associated with a higher likelihood of recommending radiation (or the option of surgery or radiation) compared with a recommendation of surgery alone. Tumor grade and patient age were significantly associated with treatment recommendation. Older age was associated with a recommendation of observation alone or a recommendation of radiation. Higher tumor grade was associated with a recommendation of surgery. There was a trend for higher hearing class to be associated with a recommendation of surgery, but this did not reach statistical significance. Race, ethnicity, and gender were not significantly associated with treatment recommendation. CONCLUSIONS: Patients with higher levels of disadvantage presented with higher tumor grade, suggesting that access to care influences diagnosis. Factors including age, ADI, and tumor grade were associated with treatment recommendation.