(883) Socioeconomic Factors in Vestibular Schwannoma Presentation and Treatment

Introduction: Vestibular schwannomas (VS) have widely variable presentation sizes and management strategies including watchful waiting, surgery and radiosurgery. Socioeconomic and geographic variation data in vestibular schwannoma presentation and treatment are limited. This study examines whether income and geographic location predict tumor size at diagnosis and receipt of surgical or radiosurgery treatment in a national cohort.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for VS patients diagnosed between 2000-2022 across 17 registries (N=21,130). Patients were stratified by county median household income quintiles (Q1=lowest to Q5=highest) and rural/urban residence. Multivariable logistic regression assessed associations between socioeconomic factors and tumor size ≥20mm at diagnosis and treatment, adjusting for confounding factors.

Results: Patients from the lowest-income counties (Q1-2) presented with larger tumors compared to Q3-5. Q1 patients had higher odds of presenting with large tumors (≥20mm) compared to Q4 (OR 1.20, 95% CI 1.08-1.33, p=0.0005). Q1 patients had lower odds of surgery than Q4 (OR 0.82, 95% CI 0.72-0.94, p=0.0032), while the highest-income patients (Q5) also had reduced surgery odds compared to Q4 (OR 0.77, 95% CI 0.68-0.88, p< 0.0001). Q1 patients were more likely to undergo radiation than Q2 (OR = 1.21, 95% CI 1.07-1.37, p=0.0031) and Q3 (OR = 1.23, 95% CI 1.09-1.40, p=0.0008), and Q5 patients were significantly more likely to undergo radiation treatment than all other income quintiles. Rural residence was independently associated with increased odds of treatment regardless of income or tumor size (OR 1.22, 95% CI 1.10-1.36, p< 0.0003).

Conclusions: Lower-income VS patients are more likely to present with larger tumors yet are less likely to undergo surgery after adjusting for tumor size. Highest income patients had significantly higher odds of undergoing radiation treatment than all other income quintiles. Rural residence independently increases treatment rates regardless of income.