Socioeconomic and geographic factors influencing pituitary tumor care in Utah

Social determinants of health (SDOHs) include non-medical factors impacting health outcomes. The prognostic role of SDOHs, such as rurality or access to healthcare, among patients with pituitary neuroendocrine tumors (pitNETs) is under-reported in the literature. We evaluated the impact of rurality and socioeconomic factors on pitNET care and management. Using data from the Utah Cancer Registry Database (2010–2019), we conducted a retrospective review, delineating patients into frontier (<6 people/sq mi), rural (6–99 people/sq mi), and urban (>100 people/sq mi) populations by their county of residence. Frontier (n = 24), rural (n = 251), and urban (n = 1135) patients traveled 106.5 (±93.9), 31.9 (±52.0), and 10.0 (±11.9) miles, respectively, to receive treatment (p < 0.001). No significant differences were observed in microadenoma resections (p = 0.822), macroadenoma resections (p = 0.149), treatment delays (p = 0.785), or follow-up length (p = 0.582). Frontier patients were more likely to be uninsured (p < 0.001) and from lower-income regions (p < 0.001). Uninsured patients were more likely to present with macroadenomas (54.7% vs. 45%, p < 0.001), undergo surgery (51.6% vs. 40.9%, p < 0.001), face longer delays from diagnosis to surgery (1.7 vs. 1.4 months, p = 0.001), and have a shorter follow-up (64.8 vs. 68.8 months, p < 0.001). While frontier patients lived farther from care facilities, no differences in decisions for surgery or delays in treatment were observed. Uninsured patients did experience larger tumors, longer delays from diagnosis to surgery, and a shorter follow-up. These results suggest that despite delays in the treatment of pitNETs, the high rates of treatment in frontier and rural populations may reflect avenues of care using available tertiary-care facilities. These results may warrant additional study to better understand improvement in rural patients’ access to care.