DISP-20. SEX DIFFERENCES IN MENINGIOMA AGGRESSIVE BEHAVIOR IN RURAL POPULATIONS: A GEO-ECOLOGICAL RISK ASSESSMENT OF MENINGIOMAS IN A SINGLE RURAL HEALTH CARE SYSTEM

Abstract BACKGROUND Cause for health outcome disparities in rural populations is multifactorial. These populations are potentially more vulnerable due to rural area environmental policies and practices. Environmental justice populations (EJP) are designated by the Environmental Protection Agency as at risk for generational exposer to environmental contaminants. We assessed these population for an association between EJP density and aggressiveness of indolent brain tumors. Meningiomas are the most common benign intracranial tumor and have a female predominance. We evaluated meningioma patients in a large rural health system for oncogenic risk associated geo-ecological factors. METHODS A retrospective review of 415 pathology confirmed CNS WHO grades 1-3 meningiomas cases between 2007 – 2017 within the Geisinger Health system in Pennsylvania. Cases were mapped by county for meningioma incidence, tumor grade, and tumor recurrence. Counties were rated for EJP density. We mapped geographic areas with a higher meningioma incidence, grade, and rates of recurrence, and evaluated sex-predilections. RESULTS Seventy-three percent of tumors were WHO grade 1 (n=303), 23.4% (n=97) were grade 2, and 3.6% (n=15) were grade 3. The highest incidence of meningiomas were localized to higher density EJP counties that bordered riverbeds, Lackawanna and Luzerne. Females had a 3.5:1 predominance as compared to males. The grade 1 10-year progression free survival rate was 54.7% in Luzerne, Columbia, and Montour counties (moderate to high density EJP). Males in high EJP counties had a 12% increased risk for developing high grade meningiomas. Males aged 51-60 were more likely to develop a grade 2 or 3 meningioma as compared to males aged 61-70 in these counties. Females aged 50-60 more likely had grade 1 meningiomas but demonstrated consistently increasing risk for recurrence every decile. CONCLUSIONS Pennsylvania high density EJP counties (especially along the Lackawanna River supply) have a disproportionate risk for aggressive meningiomas and lower progression free survival as compared to national averages. A sex-discrepancy exists for males in these areas to have the most aggressive tumors.