Glioma incidence and survival variations by county‐level socioeconomic measures. Issue 19 (17th June 2019) - Cote, David J.
Abstract : Background: Multiple studies have reported higher rates of glioma in areas with higher socioeconomic status (SES) but to the authors' knowledge have not stratified by other factors, including race/ethnicity or urban versus rural location. Methods: The authors identified the average annual age‐adjusted incidence rates and calculated hazard ratios for death for gliomas of various subtypes, stratified by a county‐level index for SES, race/ethnicity, US region, and rural versus urban status. Results: Rates of glioma were highest in counties with higher SES (rate ratio, 1.18; 95% CI, 1.15‐1.22 comparing the highest with the lowest quintiles [ P < .001]). Stratified by race/ethnicity, higher rates in high SES counties persisted for white non‐Hispanic individuals. Stratified by rural versus urban status, differences in incidence by SES were more pronounced among urban counties. Survival was higher for residents of high SES counties after adjustment for age and extent of surgical resection (hazard ratio, 0.82; 95% CI, 0.76‐0.87 comparing the highest with the lowest quintile of SES [ P < .001]). Survival was higher among white Hispanic, black, and Asian/Pacific Islander individuals compared with white non‐Hispanic individuals, after adjustment for age, SES, and extent of surgical resection, and when restricted to those individuals with glioblastoma who received radiation and chemotherapy. Conclusions: The incidence of glioma was higher in US counties of high compared with low SES. These differences were most pronounced among white non‐Hispanic individuals and white Hispanic individuals residing in urban areas. Better survival was observed in high SES counties, even when adjusting for extent of surgical resection, and when restricted to those who received radiation and chemotherapy for glioblastoma. Differences in incidence and survival were associated with SES and race, rather than rural versus urban status. Abstract : The current study examines nearly all tumors diagnosed in the United States over a 5‐year period and demonstrates a higher incidence of glioma in counties of high socioeconomic status (SES) compared with counties of low SES, although these differences generally appear to be restricted to white non‐Hispanic and white Hispanic individuals residing in urban rather than rural areas. In a survival analysis including approximately 28% of the cases from the incidence analysis, survival is better in high‐SES counties compared with low‐SES counties, even when adjusting for the extent of surgical resection and when restricting analysis to those individuals who received radiation and chemotherapy for glioblastoma.