The Impact of Social Determinants of Health on Vestibular Schwannoma Management: A Single Institution Review

Objective To evaluate social determinants of health and their effect on the management of vestibular schwannoma (VS). Study Design Retrospective chart review. Setting Tertiary referral center. Patients Patients >18 years old with sporadic VS newly diagnosed between January 1, 2010, and December 31, 2020. Intervention(s) Magnetic resonance imaging; audiogram; treatment recommendations. Main Outcome Measure(s) Differences in treatment recommendations for patients based on their social determinants of health, including race, ethnicity, and socioeconomic status. Results A total of 811 patients were included in analysis. Patients with a higher area deprivation index (ADI) presented with larger tumors. A higher ADI was associated with a higher likelihood of recommending radiation (or the option of surgery or radiation) compared with a recommendation of surgery alone. Tumor grade and patient age were significantly associated with treatment recommendation. Older age was associated with a recommendation of observation alone or a recommendation of radiation. Higher tumor grade was associated with a recommendation of surgery. There was a trend for higher hearing class to be associated with a recommendation of surgery, but this did not reach statistical significance. Race, ethnicity, and gender were not significantly associated with treatment recommendation. Conclusions Patients with higher levels of disadvantage presented with higher tumor grade, suggesting that access to care influences diagnosis. Factors including age, ADI, and tumor grade were associated with treatment recommendation.