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

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.