224 Geographic Disparities in Mortality Outcomes Among Meningioma Patients: A National Cancer Database Analysis of Metropolitan and Urban/Rural Populations

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INTRODUCTION: Disparities in geographic location may impact mortality outcomes for neurosurgical patients with meningioma. This study examines differences in 30-day and 90-day mortality between rural/urban versus metropolitan meningioma patients in the United States, utilizing data from the National Cancer Database (NCDB). METHODS: We conducted a retrospective cohort analysis of meningioma patients from the NCDB, diagnoses years 2004-2020, classified by rural/urban and metropolitan status using the United States Department of Agriculture (USDA)’s classification. Mortality outcomes included 30-day and 90-day mortality rates. Statistical analyses were performed using Brown-Mood test for continuous variables and Chi-Square test for categorical variables. Outcomes found statistically significant in these bivariate analyses were then analyzed with multivariable logistic regression analysis adjusted for demographic, socioeconomic, and clinical factors to account for potential confounders affecting mortality outcomes. RESULTS: The study included 111,492 meningioma patients, of which 17,014 (15.3%) were categorized as rural/urban and 94,478 (84.7%) were categorized as metropolitan. the bivariate analysis showed no significant difference in 30-day mortality between rural (1.9%) and urban (1.7%) patients (p = 0.0633). However, rural patients had significantly higher 90-day mortality (3.0%) compared to urban patients (2.7%) (p = 0.0186). This difference did not hold in multivariate analysis of 90-day mortality (OR=1.04, 95% CI: 0.93-1.17, P = 0.4917). CONCLUSIONS: This analysis reveals significant disparities in 90-day mortality among rural and urban meningioma patients, suggesting a need for targeted interventions to improve outcomes in rural populations. The nonsignificance in 30-day mortality suggests that early postoperative care may be adequate across geographic settings. Furthermore, the findings in 90-day mortality underscore the importance of addressing long-term follow-up care and rehabilitation accessibility for rural populations because the disparities in documentation in association with demographics, socioeconomics, and comorbidities highlight the need for consistent reporting standards to ensure equitable healthcare for all meningioma patients.

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