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Geographic disparities in access to glioblastoma treatment based on Hispanic ethnicity in the United States: Insights from a national database

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Abstract

Background

Access to treatment for glioblastoma (GBM) can be impacted by multiple demographic parameters. Barriers specific to the Hispanic population of the United States (US) are not fully understood. Therefore, the aim of this study was to elucidate geographic disparities for access to GBM treatment in the US Hispanic population.

Methods

All GBM patients with known Hispanic ethnicity status (and Caucasian race) in the US National Cancer Database (NCDB) between the years 2005–2016 were retrospectively reviewed. Treatment statuses of surgical resection, chemotherapy, radiation therapy and triple therapy (resection, chemotherapy and radiation) were summarized, and analyzed by comparison and regression analyses over US Census regions.

Results

A total cohort size of 40,232 Caucasian GBM patients were included, with 3,111 (8%) identifying as Hispanic. The odds of treatment by chemotherapy (OR 0.78, P < 0.01), radiation therapy (OR 0.82, P < 0.01) and triple therapy (OR 0.84, P < 0.01) were all significantly lower in the Hispanic group versus non-Hispanic group. The odds of being treated in the Hispanic group were significantly lower in multiple Census regions with respect to surgical resection (New England, OR 0.51; Mountain, OR 0.68), chemotherapy (East North Central, OR 0.77; Middle Atlantic, OR 0.71; Pacific, OR 0.77), radiation therapy (Middle Atlantic, OR 0.77) and triple therapy (New England, OR 0.49; Middle Atlantic, OR 0.87; Pacific, OR 0.84). Significant barriers to triple therapy in the Hispanic group within these regions were older age (OR 0.97; P < 0.01), treatment in a community facility (OR 0.85, P = 0.03), lack of insurance (OR 0.71, P = 0.03), yearly income < $40,227 (OR 0.69, P < 0.01), low education levels (OR 0.75, P = 0.03) and presence of co-morbidity (OR 0.82; P < 0.01).

Conclusions

Currently in the US, there exists heterogenous geographic disparities for Hispanic GBM patients to access different treatments compared to non-Hispanic patients. Multiple circumstances can influence access to treatment within the Hispanic community of these regions, and greater investigation with more granularity required to reveal mechanisms in which these disparities may be addressed in the future.

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Authors and Affiliations

  1. Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Jackson Health System, Miami, FL, USA

    Victor M. Lu, Ashish H. Shah, Daniel G. Eichberg, Ricardo J. Komotar & Michael E. Ivan

  2. Department of Neurologic Surgery, 200 First St. SW, Rochester, MN, 55905, USA

    Victor M. Lu

  3. Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA

    Alfredo Quinones-Hinojosa

  4. Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Yoshua Esquenazi

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  1. Victor M. Lu
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Correspondence to Victor M. Lu.

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Conflict of interest

The project described was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002736 (M.E.I.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors report no funding sources or conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Lu, V.M., Shah, A.H., Eichberg, D.G. et al. Geographic disparities in access to glioblastoma treatment based on Hispanic ethnicity in the United States: Insights from a national database. J Neurooncol 147, 711–720 (2020). https://doi.org/10.1007/s11060-020-03480-1

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