Author(s)
Ruiqi Cen, PhD MPH
Prasanth Pattisapu, MD MPH
Megan McNutt, BS
Patrick C. Walz, MD
Affiliation(s)
Nationwide Children's Hospital Center for Surgical Outcomes Research
Abstract:
Educational Objective: To identify associations between social, economic, and geographic factors and craniopharyngioma prevalence.
Objectives: Pediatric craniopharyngioma is a rare cranial base tumor with unknown pathogenesis and no identified risk factors. Prior pilot studies have identified geospatial clustering of craniopharyngioma. The objective of this investigation is to evaluate socioeconomic and geographic factors associated with craniopharyngioma prevalence.
Study Design: Correlational research.
Methods: Using the Healthcare Cost and Utilization Project state inpatient databases (HCUP SID) from 21 states with ZIP code data, we identified 358 patients with craniopharyngioma. Craniopharyngioma prevalence was calculated using the U.S. census. KIDS COUNT data were used to calculate distribution of demographic factors among the general pediatric population. Age at admission, median household income, and Child Opportunity Index 2.0 were extracted from the HCUP SID data. Levels of environmental factors were extracted from a national sample. Chi-square tests, Wilcoxon rank sum tests, and logistic regression were conducted to compare factors and assess their association with residence in high prevalence areas (prevalence >/= median).
Results: The proportion in large metropolitan areas was significantly lower among cases in high prevalence vs low prevalence areas (44.3% vs 63.1%). Cases of lower median household income were more likely to reside in high prevalence areas (OR=2.92, 1.76, 1.62, and 1.00 for the 1st - 4th income quartile). There was no dose dependent relationship between environmental exposures and craniopharyngioma prevalence.
Conclusions: Lower median household income was associated with residence in high prevalence area. Crowding is unlikely to be a contributing factor as a low proportion of cases in high craniopharyngioma prevalence areas lived in large metropolitan regions. We suspect social determinants play a role in areas of relatively high prevalence. The mechanism is unlikely related to environmental exposures but will require future research.