Racial and Socioeconomic Disparities in Access to Surgery for Pituitary Adenomas at High-volume Hospitals in the United States: A Retrospective Cohort Analysis from the National Cancer Database

Introduction: Surgery is the most common treatment for symptomatic pituitary adenomas (PAs). Although it has been shown that pituitary surgery performed at high-volume facilities (HVFs) are associated with improved outcomes, access to such hospitals may not be equitable among population subgroups. This study aimed to evaluate racial and socioeconomic differences in access to PA surgery at HVFs in the United States.

Methods: The authors retrospectively queried the National Cancer Database (NCDB) for newly diagnosed PA patients (2004-2019). Greater than 25 pituitary surgeries/year defined an HVF. Multivariable logistic regression identified patient-level predictors for undergoing surgery at an HVF and subgroup analyses determined the adjusted odds ratio of the likelihood of undergoing surgery at an HVF over time. Results with p-values ≤ 0.05 were considered statistically significant.

Results: A total of 57,807 patients were included; 47.6% (n = 27,523) underwent surgery at an HVF. On multivariable analysis, Blacks (OR: 0.89, p < 0.001) and Hispanics (OR: 0.80, p < 0.001) had significantly lower odds of undergoing surgery at a HVF (reference = White). Patients from rural locations (OR: 0.79, p = 0.003; reference = urban); with Medicaid insurance (OR: 0.86, p < 0.001; reference = private); lower-income ( < $40,227 [OR: 0.93, p = 0.049]; reference = ≥ $63,333); and patients from zip codes with large percentages of adults who did not graduate high school (≥ 17.6% [OR: 0.95, p < 0.001]; reference = < 6.3%) were significantly less likely to have surgery at an HVF.

Conclusion : The present analysis from the NCDB revealed significant racial and socioeconomic disparities in access to PA surgery at HVFs in the United States. These findings may assist health policy makers in the development of strategies to ease disparities in access to surgical care at HVFs for racially and socioeconomically disadvantaged populations.