The Socioeconomic Distressed Communities Index Predicts 90-day Mortality among Intracranial Tumor Patients

BACKGROUND Socioeconomic status (SES) is a major determinant of quality of life and outcomes. However, SES remains difficult to measure comprehensively. Distress communities index (DCI), a composite of seven socioeconomic factors, has been increasingly recognized for its correlation with poor outcomes. OBJECTIVE To determine the predictive value of DCI on outcomes following intracranial tumor surgery. METHODS A single institution, retrospective review was conducted to identify adult intracranial tumor patients undergoing resection (2016–2021). Patient ZIP codes were matched to DCI and stratified by DCI quartiles (low:0–24.9, low-intermediate:25–49.9, intermediate-high:50–74.9, high:75–100). Univariate followed by multivariate regressions assessed the effects of DCI on postoperative outcomes. Receiver operating curves (ROC) were generated for significant outcomes. RESULTS A total of 2,389 patients were included: 1,015 patients (42.5%) resided in low distress communities, 689 (28.8%) in low-intermediate distress communities, 445 (18.6%) in intermediate-high distress communities, and 240 (10.0%) in high distress communities. On multivariate analysis, risk of fracture (adjusted odds ratio [aOR]=1.60, 95% confidence interval [CI] 1.26–2.05, p<0.001) and 90-day mortality (aOR=1.58, 95%CI 1.21–2.06, p<0.001) increased with increasing DCI quartile. Good predictive accuracy was observed for both models, with ROC of 0.746 (95%CI 0.720–0.766) for fracture and 0.743 (95%CI 0.714–0.772) for 90-day mortality. CONCLUSION Intracranial tumor patients from distressed communities are at increased risk for adverse events and death in the postoperative period. DCI may be a useful, holistic measure of SES that can help risk stratifying patients and should be considered when building healthcare pathways.