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Cancer. 2019 Oct 1;125(19):3390-3400. doi: 10.1002/cncr.32328. Epub 2019 Jun 17.

Glioma incidence and survival variations by county-level socioeconomic measures.

Author information

1
Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
2
Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts.
3
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
4
Central Brain Tumor Registry of the United States, Hinsdale, Illinois.
5
Section of Epidemiology and Population Sciences, Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.
6
Bioinformatics, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
7
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.
8
Department of Neurology, Case Western Reserve University, Cleveland, Ohio.
9
Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri.
10
Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.

Abstract

BACKGROUND:

Multiple studies have reported higher rates of glioma in areas with higher socioeconomic status (SES) but to the authors' knowledge have not stratified by other factors, including race/ethnicity or urban versus rural location.

METHODS:

The authors identified the average annual age-adjusted incidence rates and calculated hazard ratios for death for gliomas of various subtypes, stratified by a county-level index for SES, race/ethnicity, US region, and rural versus urban status.

RESULTS:

Rates of glioma were highest in counties with higher SES (rate ratio, 1.18; 95% CI, 1.15-1.22 comparing the highest with the lowest quintiles [P < .001]). Stratified by race/ethnicity, higher rates in high SES counties persisted for white non-Hispanic individuals. Stratified by rural versus urban status, differences in incidence by SES were more pronounced among urban counties. Survival was higher for residents of high SES counties after adjustment for age and extent of surgical resection (hazard ratio, 0.82; 95% CI, 0.76-0.87 comparing the highest with the lowest quintile of SES [P < .001]). Survival was higher among white Hispanic, black, and Asian/Pacific Islander individuals compared with white non-Hispanic individuals, after adjustment for age, SES, and extent of surgical resection, and when restricted to those individuals with glioblastoma who received radiation and chemotherapy.

CONCLUSIONS:

The incidence of glioma was higher in US counties of high compared with low SES. These differences were most pronounced among white non-Hispanic individuals and white Hispanic individuals residing in urban areas. Better survival was observed in high SES counties, even when adjusting for extent of surgical resection, and when restricted to those who received radiation and chemotherapy for glioblastoma. Differences in incidence and survival were associated with SES and race, rather than rural versus urban status.

KEYWORDS:

disparity; glioblastoma; glioma; incidence; socioeconomic; survival

PMID:
31206646
PMCID:
PMC6744292
[Available on 2020-10-01]
DOI:
10.1002/cncr.32328

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