Assessments of social vulnerability on central nervous system cancer disparities in the United States

Authors

• David J. Fei-Zhang, Northwestern University, Chicago, IL
• Salim C. Lutfallah, LSU Health Sciences Center - New OrleansFollow
• Joshua Mensah, Northwestern University, Chicago, IL
• Daniel C. Chelius, Baylor College of Medicine, Houston, TX
• Michael W. Ruff, Mayo Clinic Neurology & Neurosurgery, Rochester, MN
• Karan Dixit, Northwestern University, Chicago, IL
• Jonas Paludo, Mayo Clinic Hematology & Oncology, Rochester, MN
• Stephanie S. Smith, Northwestern University Feinberg School of Medicine, Chicago, IL
• Urjeet A. Patel, Northwestern University Feinberg School of Medicine, Chicago, IL
• Jill N. D'Souza, LSU Health Sciences Center - New OrleansFollow
• Jeffrey C. Rastatter, Northwestern University Feinberg School of Medicine, Chicago, IL
• Anthony M. Sheyn, University of Tennessee Health Science Center, Memphis, TN

Document Type

Article

Publication Date

2-10-2026

Publication Title

Communications Medicine

Abstract

BACKGROUND: Prior investigations of the impact of social determinants of health (SDH) on people with primary central nervous system cancers (PCNSC) have considered limited SDH-factors and pathologies. This study examines how the Social Vulnerability Index (SVI) influences disparities in outcome for people with PCNSC across the United States (US). METHODS: This population-based retrospective cohort study assessed adults with PCNSC between 1975-2017 from the Surveillance-Epidemiology-End Results database, categorized using the Central Brain-Tumor-Registry of the US (CBTRUS) classifications. SDH-vulnerability/SVI scores were assigned to patients' county-of-residence based on 15 SDH-factors of socioeconomic status (SES), proportions using a minority language (ML), household composition (HC), and infrastructure/housing-transportation (HT) characteristics, plus an overall composite of these four themes. Survival and logistic regressions were obtained for survival period and multimodal treatment receipt across all PCNSC-patients based on their SVI-scores/SDH-vulnerability. RESULTS: Across 116,373 PCNSC-patients (64,841 [55.7%] male; 92,476 [79.5%] non-Hispanic white race-ethnicity), increasing overall SDH-vulnerability is associated with relative mean survival period decreases between 22.12%-45.81% across 8/8 CBTRUS-classes, with the largest-magnitude effects among HC, HT, and SES-vulnerabilities. There are decreased odds of external beam radiation for 4/8 CBTRUS-classes (lowest-embryonal: OR, 0.87; 95%CI, 0.80-0.96) and surgery for 3/8 CBTRUS classes (lowest-oligodendroglial: OR 0.96; 95%CI 0.95-0.97). The largest-magnitude effects are among those using ML, followed by impact of HC and HT characteristics. CONCLUSIONS: SDH-vulnerability associates with worse survival and treatment effects for PCNSC patients. Some specific SDH more strongly influence disparity associations, so resources could be focused more on reducing these disparity drivers.

PubMed ID

41667782

Volume

6

Issue

1

Recommended Citation

Fei-Zhang, David J.; Lutfallah, Salim C.; Mensah, Joshua; Chelius, Daniel C.; Ruff, Michael W.; Dixit, Karan; Paludo, Jonas; Smith, Stephanie S.; Patel, Urjeet A.; D'Souza, Jill N.; Rastatter, Jeffrey C.; and Sheyn, Anthony M., "Assessments of social vulnerability on central nervous system cancer disparities in the United States" (2026). School of Medicine Faculty Publications. 4504.
https://digitalscholar.lsuhsc.edu/som_facpubs/4504
10.1038/s43856-026-01409-9