173 The State of Neurosurgical Disparities Research: Past, Present, and Future

INTRODUCTION: Social determinants of health (SDH), which influence health care access, patient outcomes, and population-level burden of disease, contribute to health disparities experienced by marginalized patient populations. METHODS: Embase, Ovid-MEDLINE, Scopus, Web of Science, Cochrane Library, and ProQuest Dissertations databases were queried for original research on health disparities regarding access to, outcomes of, or postoperative-management following neurosurgical procedures in the U.S. with at least one neurosurgical-affiliated author. RESULTS: Of 642 studies screened, 109 were included. Eighty-eight articles met all inclusion criteria other than having a neurosurgical-affiliated author and were excluded. Six studies were published prior to 2010 and 56 in the past 5 years with 62% utilizing national databases, 28% institutional databases, and 11% employing local/state/regional databases. Disparities analyzed were racial/ethnic (79%), economic/socioeconomic (59%), gender (19%), and disabled populations (0.9%) with 43% analyzing multiple/intersecting disparities. Common outcome measures were postoperative outcomes (59%), access to neurosurgical procedures (48%), and post-operative management (9%). Neuro-oncology was the most prevalent subspecialty evaluated (28%) followed by spine (26%), then pediatrics (14%), functional (11%), vascular (12%), general (7%), and trauma (3%). Senior authors with neurosurgical affiliations accounted for 87% of papers, 99% of whom were academically affiliated, and were most located in the South (29%), followed by the Northeast (28%), West (27%), and Midwest (15%). CONCLUSIONS: The majority of studies used national databases, assessed racial/ethnic disparities, and focused on postoperative outcomes. Many articles did not have a neurosurgery-affiliated author and the subspecialties of pediatrics, functional, vascular, and trauma were relatively underrepresented. Future research regarding SDH for neurosurgical patients will be crucial to increase healthcare access, improve outcomes, and achieve equity for marginalized patient populations. Moreover, it will be crucial for neurosurgery-affiliated researchers to engage in SDH research to increase visibility and impact of this area in neurosurgery.