The association of economic measures and patient outcomes with geographical disparities in access to a UCNS board-certified neuro-oncologist in the United States.

2039 Background: Neuro-oncology is increasingly centralized in academic tertiary centers, potentially creating geographic and economic inequality. This study aims to quantify the national distribution of neuro-oncologists in the United States and evaluate the association between regional economic capacity, metropolitan urbanicity, and population-level clinical outcomes. Methods: We conducted a nationwide cross-sectional ecological analysis using 2025 United Council for Neurologic Subspecialties (UCNS) data, US Bureau of Economic Analysis state-level GDP, and US Census Bureau demographics. Spatial accessibility was modelled for US counties using geodesic distance from population centroids. Outcome measures included CNS tumor mortality and Disability-Adjusted Life Years (DALYs). Results: We identified 323 UCNS board-certified neuro-oncologists distributed across 70 Metropolitan Statistical Areas (MSAs). Workforce distribution was strongly associated with state-level economic magnitude (r=0.930 [95% CI: 0.878–0.960], p<0.0001), with gross domestic product (GDP) explaining 86.4% of variance (R2=0.864). Critically, economic intensity independent of state population was a significant driver, with GDP per capita correlating with specialist density (r=0.344, p=0.014). Specialists were located exclusively within MSAs (𝜒² = 52.28, p < 0.0001), however 81.9% of MSAs lacked local subspecialty presence. Spatial analysis revealed 45.4% of the US population has local access (<20 miles), while 16.5% (55.2 million Americans) live in "Care Deserts" greater than 100 miles from the nearest neuro-oncologist. Increased specialist density predicted lower mortality rates for pediatric (ρ = –0.34 [95% CI: –0.56 to –0.07], p = 0.015) and adult (ρ = –0.352 [95% CI: –0.57 to –0.08], p = 0.011) groups. Similar inverse associations were observed for DALYs in both pediatric (ρ=−0.339 [95% CI: –0.57 to –0.07], p = 0.015) and adult (ρ=−0.347 [95% CI: –0.57 to –0.08], p = 0.013) populations. Conclusions: Distribution of UCNS board-certified neuro-oncologists in the United States is primarily governed by state-level economic prosperity and is critically concentrated in select metropolitan centers. This geographical concentration leaves over 80% of US metro areas without access to a UCNS board-certified neuro-oncologist. Furthermore, higher density of UCNS-certified specialists is significantly associated with reduced mortality and disease burden, suggesting that expanding this workforce may be a lever for improving population-level neuro-oncologic outcomes.