Abstract We explore the interactions between socioeconomic status (SES) and race in influencing vestibular schwannoma (VS) management and evolution over the last two decades. This analysis collated demographic and clinical data for 23,488 VS cases from 2004 to 2021 using the National Surveillance, Epidemiology, and End Results database. Relationships between tumor size, SES, and race were analyzed with chi-square and logistic regression. Analyses were completed for the whole cohort, then repeated for the 2016 to 2021 cohort only, to assess trends. Black patients across SES are less likely to have VS surgery than non-Black patients (p < 0.001). Black patients of all quintiles are less likely to undergo surgery than patients of any SES in other race categories, a trend that persisted in the 2016 to 2021 cohort. SES was significantly associated with treatment modality for Hispanic, Asian, and white populations (p < 0.001 for all) but only approaching significance in Black patients (p = 0.095); this persisted in the 2016 to 2021 cohort. For the whole cohort and when analysis was restricted to 2016 to 2021, race, SES, and tumor size were all significant predictors of treatment (all p < 0.001). When apparent racial disparities are discovered, the question of SES as a confounding factor often arises. Our results support that decreased surgical intervention in VS for Black patients is not solely attributable to SES. SES was found to have a significant impact on treatment for all except Black patients. Race remains a determinant of treatment modality in the 2016 to 2021 cohort despite increased awareness of racial health disparities accelerated by the COVID-19 pandemic.
Dreyer et al. (2026) studied this question.