{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T16:11:10Z","timestamp":1781885470945,"version":"3.54.5"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:00:00Z","timestamp":1738800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Prior investigations into meningioma disparities have explored associative relationships of socioeconomic status (SES) and race-ethnicity but face gaps in the range of other social determinants\/drivers of health (SDoH) factors considered and sample size. Furthermore, none have explored causal relationships between SDoH-factors and outcomes. Thus, this study aims to utilize a recent, national sampling of meningioma patients incorporating comprehensive inferential and causal-mediation approaches to delineate which SDoH-factors objectively drive care and prognostic disparities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective study of a specialized Surveillance-Epidemiology-End Results 2020 dataset for community-\/census tract-level (Yost-Index, a composite SES measure and Rurality-Urbanicity) and individual-level (sex, race-ethnicity) SDoH-factors performed age-adjusted multivariate cox-hazards and logistic regressions, and covariate-adjusted causal-mediation analyses to assess differences in overall survival, treatment receipt, and delay of treatment initiation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In age-adjusted multivariate analyses of 110,042 meningioma patients from 2010-2018, lower community-level SES significantly increased overall mortality (HR 1.31, 95%CI 1.28-1.34), decreased interventional treatment receipt (Surgery-OR 0.89, 95%CI 0.87-0.91; Radiation 0.83, 0.79-0.87), and increased treatment delay (1.13, 1.09-1.16). Minoritized race\/ethnicity featured increased interventional treatment receipt (Surgery 1.18, 1.15-1.22; Radiation 1.18, 1.12-1.24) and decreased treatment delay (0.90, 0.87-0.93). In covariate-adjusted causal analyses, community-level SES showed total mediation effects of race-ethnicity in influencing overall survival and negative partial mediation effects in treatment receipt and delay.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>For overall survival, community-level SES primarily drove meningioma disparities even when accounting for other SDoH-factors. For treatment receipt and delay, race-ethnicity caused greater differences that were partially affected by community-level SES. In turn, these comprehensive analyses provide definitive causes of meningioma disparities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/nop\/npaf020","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T21:18:16Z","timestamp":1738790296000},"page":"691-699","source":"Crossref","is-referenced-by-count":1,"title":["Causal assessments of multilevel social determinant factors on meningioma disparities in the United States"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4485-8274","authenticated-orcid":false,"given":"David J","family":"Fei-Zhang","sequence":"first","affiliation":[{"name":"Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishabh","family":"Sethia","sequence":"additional","affiliation":[{"name":"Department of Pediatric Otolaryngology, Nationwide Children\u2019s Hospital , Columbus, OH ,","place":["USA"]},{"name":"Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry W","family":"Wang","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M","family":"Sheyn","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center , Memphis, TN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill N","family":"D\u2019Souza","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center Department of Otolaryngology and Division of Pediatric Otolaryngology Children\u2019s Hospital of New Orleans , New Orleans, LA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C","family":"Chelius","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey C","family":"Rastatter","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago , Chicago, IL ,","place":["USA"]},{"name":"Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,6]]},"reference":[{"issue":"Suppl 5","key":"2025081316520800100_CIT0001","doi-asserted-by":"crossref","first-page":"v1","DOI":"10.1093\/neuonc\/noac202","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015\u20132019","volume":"24","author":"Ostrom","year":"2022","journal-title":"Neuro-Oncology."},{"issue":"3","key":"2025081316520800100_CIT0002","doi-asserted-by":"crossref","first-page":"pkab035","DOI":"10.1093\/jncics\/pkab035","article-title":"Incidence of benign meningiomas in the United States: current and future trends","volume":"5","author":"Bhala","year":"2021","journal-title":"JNCI Cancer Spectr"},{"issue":"3","key":"2025081316520800100_CIT0003","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s11060-010-0386-3","article-title":"Epidemiology and etiology of meningioma","volume":"99","author":"Wiemels","year":"2010","journal-title":"J Neurooncol."},{"issue":"1","key":"2025081316520800100_CIT0004","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":"Jackson","year":"2022","journal-title":"Neurosurgery."},{"issue":"3","key":"2025081316520800100_CIT0005","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s11060-023-04393-5","article-title":"Associations of race and socioeconomic status with outcomes after intracranial meningioma resection: a systematic review and meta-analysis","volume":"163","author":"Lei","year":"2023","journal-title":"J Neurooncol."},{"issue":"1","key":"2025081316520800100_CIT0006","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s11060-020-03581-x","article-title":"Impact of insurance on hospital course and readmission after resection of benign meningioma","volume":"149","author":"Hauser","year":"2020","journal-title":"J Neurooncol."},{"issue":"Suppl 1","key":"2025081316520800100_CIT0007","first-page":"i5","article-title":"The joint impacts of sex and race\/ethnicity on incidence of grade 1 versus grades 2\u20133 meningioma across the lifespan","volume":"5","author":"Walsh","year":"2023","journal-title":"Neurooncol. Adv.."},{"key":"2025081316520800100_CIT0008","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 treatment","volume":"187","author":"Gautam","year":"2024","journal-title":"World Neurosurg"},{"issue":"10368","key":"2025081316520800100_CIT0009","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1016\/S0140-6736(22)00839-X","article-title":"Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis","volume":"400","author":"Butterfield","year":"2022","journal-title":"Lancet (London, England)"},{"issue":"1","key":"2025081316520800100_CIT0010","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s11060-022-04085-6","article-title":"Incidence trends and survival analysis of atypical meningiomas: a population-based study from 2004 to 2018","volume":"160","author":"Recker","year":"2022","journal-title":"J Neurooncol."},{"issue":"4","key":"2025081316520800100_CIT0011","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1080\/00207454.2020.1818742","article-title":"The effect of socioeconomic status on age at diagnosis and overall survival in patients with intracranial meningioma","volume":"132","author":"Brewster","year":"2022","journal-title":"Int J Neurosci."},{"issue":"2","key":"2025081316520800100_CIT0012","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s11060-020-03455-2","article-title":"Racial and socioeconomic correlates of treatment and survival among patients with meningioma: a population-based study","volume":"147","author":"Bhambhvani","year":"2020","journal-title":"J Neurooncol."},{"issue":"6","key":"2025081316520800100_CIT0013","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1055\/s-0038-1676376","article-title":"Geographical differences in intracranial meningioma management: examining 65,973 patients across the United States","volume":"80","author":"Anzalone","year":"2019","journal-title":"J Neurol Surg B Skull Base"},{"issue":"3","key":"2025081316520800100_CIT0014","doi-asserted-by":"crossref","first-page":"368","DOI":"10.3171\/2014.12.SPINE14974","article-title":"Effects of sex on the incidence and prognosis of spinal meningiomas: a surveillance, epidemiology, and end results study","volume":"23","author":"Westwick","year":"2015","journal-title":"J Neurosurg Spine"},{"issue":"8","key":"2025081316520800100_CIT0015","first-page":"703","article-title":"Socioeconomic status and breast cancer incidence in California for different race\/ethnic groups","volume":"12","author":"Yost","year":"2001","journal-title":"Cancer Causes Control."},{"key":"2025081316520800100_CIT0016","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1146\/annurev.psych.58.110405.085542","article-title":"Mediation analysis","volume":"58","author":"MacKinnon","year":"2007","journal-title":"Annu Rev Psychol."},{"issue":"24","key":"2025081316520800100_CIT0017","doi-asserted-by":"crossref","first-page":"4376","DOI":"10.1002\/cncr.29639","article-title":"Extent of resection and overall survival for patients with atypical and malignant meningioma","volume":"121","author":"Aizer","year":"2015","journal-title":"Cancer."},{"key":"2025081316520800100_CIT0018","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1016\/j.wneu.2024.07.140","article-title":"The impact of social determinants on receipt of adjuvant radiation nationally following atypical meningioma surgery","volume":"190","author":"Chisango","year":"2024","journal-title":"World Neurosurg"},{"issue":"11","key":"2025081316520800100_CIT0019","doi-asserted-by":"crossref","first-page":"e0224278","DOI":"10.1371\/journal.pone.0224278","article-title":"Sex differences in the treatment and outcome of emergency general surgery","volume":"14","author":"Rucker","year":"2019","journal-title":"PLoS One."},{"issue":"4","key":"2025081316520800100_CIT0020","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.5435\/JAAOSGlobal-D-24-00083","article-title":"Sex-based differences in patient perspectives and experiences with shoulder, hip, and knee arthroplasty","volume":"8","author":"Chi","year":"2024","journal-title":"JAAOS Glob Res Rev"},{"issue":"12","key":"2025081316520800100_CIT0021","doi-asserted-by":"crossref","first-page":"e009050","DOI":"10.1161\/CIRCOUTCOMES.122.009050","article-title":"Sex disparities in failure to rescue after cardiac surgery in California and New York","volume":"15","author":"Alabbadi","year":"2022","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"2","key":"2025081316520800100_CIT0022","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s11060-019-03378-7","article-title":"Socioeconomic factors affect treatment delivery for patients with low grade glioma: a Swedish population-based study","volume":"146","author":"Carstam","year":"2020","journal-title":"J Neurooncol."},{"issue":"4","key":"2025081316520800100_CIT0023","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/neuonc\/noad223","article-title":"Association of county-level socioeconomic status with meningioma incidence and outcomes","volume":"26","author":"Pugazenthi","year":"2024","journal-title":"Neuro-Oncology"},{"issue":"4","key":"2025081316520800100_CIT0024","doi-asserted-by":"crossref","first-page":"717","DOI":"10.3758\/BF03206553","article-title":"SPSS and SAS procedures for estimating indirect effects in simple mediation models","volume":"36","author":"Preacher","year":"2004","journal-title":"Behav Res Methods Instrum Comput."},{"key":"2025081316520800100_CIT0025","doi-asserted-by":"crossref","first-page":"117508","DOI":"10.1016\/j.neuroimage.2020.117508","article-title":"Identifying neural signatures mediating behavioral symptoms and psychosis onset: High-dimensional whole brain functional mediation analysis","volume":"226","author":"Ch\u00e9n","year":"2021","journal-title":"Neuroimage."},{"key":"2025081316520800100_CIT0026","doi-asserted-by":"crossref","first-page":"118643","DOI":"10.1016\/j.neuroimage.2021.118643","article-title":"Neural mediators of subjective and autonomic responding during threat learning and regulation","volume":"245","author":"Savage","year":"2021","journal-title":"Neuroimage."},{"issue":"3","key":"2025081316520800100_CIT0027","first-page":"226","article-title":"The relationship between social determinants of health and neurocognitive and mood-related symptoms in the primary brain tumor population: A systematic review","volume":"11","author":"Stockdill","year":"2024","journal-title":"Neurooncol. Pract.."},{"issue":"46","key":"2025081316520800100_CIT0028","doi-asserted-by":"crossref","first-page":"e17960","DOI":"10.1097\/MD.0000000000017960","article-title":"Mediation analyses of socioeconomic factors determining racial differences in the treatment of diffuse large B-cell lymphoma in a cohort of older adults","volume":"98","author":"Guadamuz","year":"2019","journal-title":"Medicine (Baltim)."},{"issue":"2","key":"2025081316520800100_CIT0029","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1089\/thy.2023.0370","article-title":"Social vulnerability association with thyroid cancer disparities in the United States","volume":"34","author":"Fei-Zhang","year":"2024","journal-title":"Thyroid"},{"issue":"2","key":"2025081316520800100_CIT0030","doi-asserted-by":"crossref","first-page":"e230016","DOI":"10.1001\/jamanetworkopen.2023.0016","article-title":"Assessment of social vulnerability in pediatric head and neck cancer care and prognosis in the United States","volume":"6","author":"Fei-Zhang","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"2025081316520800100_CIT0031","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1002\/jso.27257","article-title":"The impact of digital inequities on gastrointestinal cancer disparities in the United States","volume":"128","author":"Fei-Zhang","year":"2023","journal-title":"J Surg Oncol."},{"issue":"6","key":"2025081316520800100_CIT0032","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/MOO.0000000000000931","article-title":"Large-data contextualizations of social determinant associations in pediatric head and neck cancers","volume":"31","author":"Fei-Zhang","year":"2023","journal-title":"Curr Opin Otolaryngol Head Neck Surg."},{"issue":"1","key":"2025081316520800100_CIT0033","doi-asserted-by":"crossref","first-page":"104066","DOI":"10.1016\/j.amjoto.2023.104066","article-title":"The impact of digital inequities on laryngeal cancer disparities in the US","volume":"45","author":"Edwards","year":"2024","journal-title":"Am J Otolaryngol."},{"issue":"23","key":"2025081316520800100_CIT0034","doi-asserted-by":"crossref","first-page":"5522","DOI":"10.3390\/cancers15235522","article-title":"The impact of digital inequities on esophageal cancer disparities in the US","volume":"15","author":"Fei-Zhang","year":"2023","journal-title":"Cancers"},{"issue":"9","key":"2025081316520800100_CIT0035","doi-asserted-by":"crossref","first-page":"2152","DOI":"10.1002\/hed.27783","article-title":"Assessing social vulnerabilities of salivary gland cancer care, prognosis, and treatment in the United States","volume":"46","author":"Bindra","year":"2024","journal-title":"Head Neck."},{"issue":"4 Pt B","key":"2025081316520800100_CIT0036","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.jacr.2018.12.023","article-title":"An introduction to health disparities for the practicing radiologist","volume":"16","author":"Safdar","year":"2019","journal-title":"J Am Coll Radiol."},{"issue":"5","key":"2025081316520800100_CIT0037","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.jacr.2020.12.009","article-title":"Exacerbation of inequities in use of diagnostic radiology during the early stages of reopening after COVID-19","volume":"18","author":"Lacson","year":"2021","journal-title":"J Am Coll Radiol."}],"container-title":["Neuro-Oncology Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/nop\/advance-article-pdf\/doi\/10.1093\/nop\/npaf020\/61772267\/npaf020.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/nop\/article-pdf\/12\/4\/691\/61772267\/npaf020.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/nop\/article-pdf\/12\/4\/691\/61772267\/npaf020.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T20:52:19Z","timestamp":1755118339000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/nop\/article\/12\/4\/691\/8002799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,6]]},"references-count":37,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2,6]]},"published-print":{"date-parts":[[2025,8,13]]}},"URL":"https:\/\/doi.org\/10.1093\/nop\/npaf020","relation":{},"ISSN":["2054-2577","2054-2585"],"issn-type":[{"value":"2054-2577","type":"print"},{"value":"2054-2585","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,2,6]]}}}