{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T23:18:58Z","timestamp":1783120738728,"version":"3.54.6"},"reference-count":53,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Meningiomas are benign tumors that surround the brain and spinal cord. While studies have examined disparities in meningioma outcomes nationally, the meningioma mortality rate based on urbanization level is unclear. This study utilized the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to investigate meningioma mortality rates and disparities between urbanization categories.<\/jats:p>\n                  <jats:p>Patients whose underlying cause of death was meningioma from 1999 to 2020 were included. Chi-squared testing determined mortality differences across urbanization groups (large central metro, large fringe metro, and medium metro). Multivariable logistic regression and adjusted odds ratios (OR) evaluated associations between death location and age, sex, race, and ethnicity. Age-adjusted meningioma mortality rates per 100,000 people with 95% confidence intervals (CIs) were reported.<\/jats:p>\n                  <jats:p>We analyzed a cohort of 12,274 patients. All older age groups demonstrated significantly lower odds of mortality in large central metros compared with other regions (OR: 0.54\u20130.69; p\u2009&lt;\u20090.05). Men had higher odds of dying in large central metro areas compared with women (OR: 1.09; p\u2009=\u20090.047). Asian and African American patients had significantly higher odds of meningioma mortality in large central metros compared with their counterparts (OR: 7.53 vs. 3.42; p\u2009&lt;\u20090.001). Similarly, Hispanic\/Latino ethnicity was associated with an increased likelihood of death in large central metros (OR: 6.97; p\u2009&lt;\u20090.001), but a lower likelihood in medium metros (OR: 0.77; p\u2009=\u20090.029). No significant changes in mortality rates were observed based on urbanization.<\/jats:p>\n                  <jats:p>We report that urbanization plays a significant role in meningioma mortality, with varying effects by sex, race, ethnicity, and age.<\/jats:p>","DOI":"10.1055\/a-2642-0933","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T11:00:22Z","timestamp":1752231622000},"page":"448-455","source":"Crossref","is-referenced-by-count":1,"title":["Geographic Trends and Disparities in Meningioma Mortality: A National Observational Study from 1999 to 2020 Utilizing the CDC Wonder Database"],"prefix":"10.1055","volume":"87","author":[{"given":"Jaskeerat","family":"Gujral","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Om H.","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang W.","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali K.","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Welch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mert M.","family":"Dagli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"ref1","volume-title":"Meningioma","author":"A A Alruwaili","year":"2025"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s11060-010-0386-3","article-title":"Epidemiology and etiology of meningioma","volume":"99","author":"J Wiemels","year":"2010","journal-title":"J Neurooncol"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.3390\/biomedicines9030319","article-title":"Meningioma: a review of epidemiology, pathology, diagnosis, treatment, and future directions","volume":"9","author":"C Ogasawara","year":"2021","journal-title":"Biomedicines"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"CNS72","DOI":"10.2217\/cns-2021-0003","article-title":"Meningioma: not always a benign tumor. A review of advances in the treatment of meningiomas","volume":"10","author":"I Maggio","year":"2021","journal-title":"CNS Oncol"},{"issue":"10","key":"ref5","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1093\/neuonc\/nox071","article-title":"Brain invasion in meningiomas-clinical considerations and impact of neuropathological evaluation: a systematic review","volume":"19","author":"B Brokinkel","year":"2017","journal-title":"Neuro-oncol"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1227\/NEU.0000000000001751","article-title":"Racial and socioeconomic disparities in patients with meningioma: a retrospective cohort study","volume":"90","author":"H N Jackson","year":"2022","journal-title":"Neurosurgery"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"e289","DOI":"10.1016\/j.wneu.2024.04.076","article-title":"Socioeconomic and Racial Disparities Affect Access to High-Volume Centers During Meningioma 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state hospitals and in-hospital mortality","volume":"27","author":"R A Solomon","year":"1996","journal-title":"Stroke"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1007\/s10903-018-0763-0","article-title":"Limited English proficiency and health service use in Asian Americans","volume":"21","author":"Y Jang","year":"2019","journal-title":"J Immigr Minor Health"},{"issue":"01","key":"ref28","first-page":"21","article-title":"Barriers to health care access in 13 Asian American communities","volume":"34","author":"S Lee","year":"2010","journal-title":"Am J Health Behav"},{"issue":"04","key":"ref29","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1227\/neu.0000000000002080","article-title":"Association of language barriers with process outcomes after craniotomy for brain tumor","volume":"91","author":"S P Manuel","year":"2022","journal-title":"Neurosurgery"},{"key":"ref30","doi-asserted-by":"publisher","volume-title":"National Academies of 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Med"},{"issue":"11","key":"ref39","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.2215\/CJN.03170318","article-title":"Patient experience with primary care physician and risk for hospitalization in Hispanics with CKD","volume":"13","author":"E A Cedillo-Couvert","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"issue":"16","key":"ref40","doi-asserted-by":"crossref","first-page":"2870","DOI":"10.3390\/cancers16162870","article-title":"Challenges and opportunities in accessing surgery for glioblastoma in low-middle income countries: a narrative review","volume":"16","author":"P Tini","year":"2024","journal-title":"Cancers (Basel)"},{"issue":"03","key":"ref41","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1001\/archsurg.2009.288","article-title":"Disparities in access to neuro-oncologic care in the United States","volume":"145","author":"D Mukherjee","year":"2010","journal-title":"Arch Surg"},{"issue":"07","key":"ref42","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.1002\/jmri.26638","article-title":"Accessible magnetic resonance imaging: a review","volume":"49","author":"S Geethanath","year":"2019","journal-title":"J Magn Reson Imaging"},{"issue":"06","key":"ref43","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1002\/jmri.26637","article-title":"Low-field MRI: an MR physics perspective","volume":"49","author":"J P Marques","year":"2019","journal-title":"J Magn Reson Imaging"},{"issue":"09","key":"ref44","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/j.jacr.2014.03.026","article-title":"White paper report of the 2013 RAD-AID conference: improving radiology in resource-limited regions and developing countries","volume":"11","author":"D J Mollura","year":"2014","journal-title":"J Am Coll Radiol"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1744-8603-6-18","article-title":"Turning a blind eye: the 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Modh","year":"2019","journal-title":"Cureus"},{"issue":"01","key":"ref49","first-page":"vdad113","article-title":"Addressing disparities in delivery of cancer care for patients with melanoma brain metastases-not just a simple case of rurality","volume":"5","author":"J Riggs","year":"2023","journal-title":"Neurooncol Adv"},{"issue":"01","key":"ref50","doi-asserted-by":"crossref","first-page":"123","DOI":"10.4103\/jnrp.jnrp_273_17","article-title":"The current state of rural neurosurgical practice: an international perspective","volume":"9","author":"P S Upadhyayula","year":"2018","journal-title":"J Neurosci Rural Pract"},{"issue":"03","key":"ref51","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/01.sla.0000179624.50455.db","article-title":"Neurosurgical coverage: essential, desired, or irrelevant for good patient care and trauma center status","volume":"242","author":"T J Esposito","year":"2005","journal-title":"Ann 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