2025 Proffered Presentations
S209: TRENDS AND DISPARITIES IN MENINGIOMA MORTALITY ACROSS METROPOLITAN AREAS IN THE UNITED STATES
Jaskeerat Gujral; Om H Gandhi; Swarith Reddy; Mert Marcel Dagli, MD; Wiliam C Welch, MD; University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background: Meningiomas are typically slow-growing, benign tumors originating from the arachnoid membrane surrounding the brain and spinal cord. Past studies have examined meningioma outcomes disparities nationally, but analyzing location-specific meningioma mortality trends by urbanization level can better identify geographic risk factors, access to care issues, and health disparities obscured in national data. Thus, this study aimed to evaluate meningioma mortality rates and disparities between cities grouped by urbanization size to inform healthcare providers and policymakers on tailored prevention and treatment strategies.
Methods: We analyzed a cohort of 12,274 patients whose underlying cause of death was meningioma, based on death certificate data from the CDC WONDER database from 1999-2020. Multivariable logistic regression and adjusted odds ratios (OR) via Bayesian standardization of 25 variables was calculated to evaluate associations between urbanization of death location and decedent age, sex, race, and ethnicity. Urban locations were categorized as large central metro (e.g. New York City), large fringe metro (e.g. Dallas-Fort Worth), and medium metro (e.g. Milwaukee) based on population size and proximity. Meningioma mortality trends over 1999-2020 were also analyzed by urbanization level via linear regression. Analyses were performed via R with P<0.05 considered significant.
Results: Although 63.8% of meningioma decedents were female, men had modestly higher odds of dying in large central metro areas compared to women (OR 1.09, P<0.05), but this disparity was not observed in large fringe metro areas and medium metro areas. Racial disparities were more pronounced, with Asian and African-American patients having significantly higher odds of meningioma mortality in large central metros compared to White patients (OR 7.53 vs 3.42, P<0.001). However, in large fringe metros and medium metros, White patients had higher odds of death (OR 2.22, P<0.001). Similarly, Hispanic/Latino ethnicity was associated with increased likelihood of death in large central metros (OR 6.97, P<0.001), but lower likelihood in large fringe metros (OR 0.38, P<0.001) and medium metros (OR 0.77, P<0.05) compared to non-Hispanic White patients. Patients younger than 44 years had increased odds of death in large central metros (OR 1.75, P<0.001) versus all other age groups, but no age-related disparities were found in large fringe metro areas and medium metro areas. These socioeconomic disparities in meningioma mortality based on urbanization have persisted over the past two decades, with no significant changes from 1999 to 2020 (P<0.05).
Conclusions: This study revealed that while socioeconomic inequities have alarmingly endured over two decades nationwide, urbanization strongly alters these disparities’ direction and magnitude. Contrary to national trends, male sex, minority race/ethnicity, and young age predicted increased meningioma mortality risk only in major metros, with reverse or null effects in smaller and fringe cities. This reversal highlights that grouping outcomes on a national level obscures local social and structural factors driving health inequities. Granular examination of how geographic context modifies demographic mortality risk is vital to tailor interventions.