Individual and community-level associations of social determinants with pituitary adenoma disparities in the US

Authors

• Atharva Desai, University of Missouri-Kansas City School of Medicine, Kansas City, KS
• Manal Malik, Tulane University, New Orleans, LA
• Charles J. Cook, Baylor College of Medicine, Houston, TX
• David J. Fei-Zhang, Northwestern University Feinberg, Chicago, IL
• Christopher Puchi, Northwestern University, Chicago, IL
• Jill N. King, University of North Carolina Medical Center, Chapel Hill, NC
• William L. Hickerson, Regional One Health, Memphis, TN
• Joshua S. Carson, Loyola Burn Center, Maywood, IL
• Derek E. Bell, University of Rochester Medical Center, Rochester, NY
• Steven A. Kahn, Medical University of South Carolina, Charleston, SC
• C. Scott Hultman, WakeMed Health and Hospitals, Raleigh, NC
• Rajiv Sood, Doctors Hospitall, Augusta, GA
• Anjay Khandelwal, Akron Children's Hospital, Akron, OH
• Fiona M. Wood, Royal Perth Hospital
• James H. Holmes IV, Wake Forest Baptist Health

Document Type

Article

Publication Date

8-5-2026

Publication Title

Journal of Neuro Oncology

Abstract

Purpose: Through interactional, multilevel models of social determinants of health (SDoH) incorporating comprehensive census-level and individual-level SDoH-factors, to assess whether pituitary adenoma disparities are more strongly associated with community-level factors compared to individual-level ones. Methods: This retrospective study analyzed pituitary adenoma patients nationally between 2010 and 2018 using multivariate, age-adjusted regressions and cox-proportional hazards models; covariates of sex, race-ethnicity, census-level rurality-urbanicity, census-level Yost-Index score (aggregating 7 SES-measures of education, income, housing) and clinical outcomes of mortality, surgical resection, & delays-in-treatment (3 months-or-over from diagnosis). Results: Across 44,514 pituitary adenomas-patients, all-cause mortality featured markedly positive independent predictors of decreasing Yost-SES (OR, 1.43; 95% CI, 1.35–1.52; p < 0.001) and Male-Sex (OR, 1.24; 95% CI, 1.16–1.32; p < 0.001). Indicated surgery receipt showed markedly positive independent predictors of Male-Sex (OR, 1.64; 95% CI, 1.59–1.72; p < 0.001), Minority Race/Ethnicity (OR, 1.18; 95% CI, 1.14–1.23; p < 0.001), and Rurality (OR, 1.08; 95% CI, 1.01–1.16; p = 0.030). Having a delay-of-treatment showed markedly positive independent predictors of Female-Sex (OR, 1.24; 95% CI, 1.18–1.30; p < 0.001) and decreasing Yost-SES (OR, 1.14; 95% CI, 1.08–1.20; p < 0.001). Conclusions: Through assessing individual- and community-level social determinants in tandem, this study identified detrimental SDoH-associations with pituitary adenoma care and prognosis. Community-level Yost-Index SES and individual sex showed stronger associations with observed disparities, presenting multilevel considerations for prospective initiatives to consider.

PubMed ID

42554885

Volume

179

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Desai, Atharva; Malik, Manal; Cook, Charles J.; Fei-Zhang, David J.; Puchi, Christopher; King, Jill N.; Hickerson, William L.; Carson, Joshua S.; Bell, Derek E.; Kahn, Steven A.; Hultman, C. Scott; Sood, Rajiv; Khandelwal, Anjay; Wood, Fiona M.; and Holmes IV, James H., "Individual and community-level associations of social determinants with pituitary adenoma disparities in the US" (2026). School of Medicine Faculty Publications. 4989.
https://digitalscholar.lsuhsc.edu/som_facpubs/4989
10.1007/s11060-026-05716-y