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September 10, 2025

The impact of neighborhood-level disadvantage on symptoms, mood, and health related quality of life among the primary brain tumor population

Key Points

Greater symptom severity was reported by patients in more disadvantaged neighborhoods, indicating significant health disparities.
Among low-grade tumor patients, those in disadvantaged neighborhoods exhibited worse interference with daily activities and increased anxiety.
Linear regression models showed a clear association between population density and health outcomes in the primary brain tumor population.
Findings suggest that future research should assess the impact of regional resources on symptoms among under-resourced populations.

Abstract

Abstract Background Evidence assessing the impact of neighborhood-level disadvantage and population density on outcomes of individuals with cancer is growing but has not been evaluated among the primary brain tumor (PBT) population. We evaluated associations of neighborhood-level disadvantage and population density with symptoms and health-related quality of life (HRQOL) among adults with a PBT. Methods Neighborhood-level disadvantage, measured using the Area Deprivation Index (ADI), and population density were evaluated against symptoms (MDASI-BT and PROMIS Anxiety/Depression Short Forms v1.0 8a) using linear regression models and against HRQOL (EQ-5D-3L) using logistic regression models. Models were adjusted for age, sex, race/ethnicity, tumor grade, functional status, and tumor recurrence. Results were stratified by tumor grade. Results Of 643 participants, 24% lived in more disadvantaged neighborhoods, while 39% resided in non-urbanized areas. Patients in more disadvantaged neighborhoods reported greater symptom severity (β=1.10, 95%CI 1.00, 1.20, P=0.041) and activity-related interference (β=1.11, 95%CI 1.01, 1.22, P=0.03) than those in less disadvantaged neighborhoods. Among patients with low-grade tumors, living in more disadvantaged neighborhoods was associated with worse symptom interference (β=1.24, 95%CI 1.04, 1.50, P=0.020), anxiety (β=1.03, 95%CI 1.01, 1.06, P=0.023), and difficulties with mobility (OR=3.30, 95%CI 1.09, 10.01, P=0.035) and self-care (OR=4.68, 95%CI 1.46, 14.96, P=0.009). Patients in non-urbanized areas were more likely to experience difficulties with self-care (OR=2.07, 95%CI 1.23, 3.48, P=0.006) than those in urbanized areas. Conclusion Future studies should consider evaluating PBT symptoms with data on regional resources outside of individual income as the next step to inform interventional work with under-represented and under-resourced populations. Trial Registration Number NCT#: NCT02851706

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The impact of neighborhood-level disadvantage on symptoms, mood, and health related quality of life among the primary brain tumor population

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