Socioeconomic disparities in vestibular schwannoma diagnosis and management: A systematic review.
This PRISMA-guided systematic review of 40 adult sporadic vestibular schwannoma studies (358,843 patients) found that race and insurance status were the socioeconomic factors most consistently associated with differences in management and outcomes.
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This PRISMA-guided systematic review of 40 adult sporadic vestibular schwannoma studies (358,843 patients) found that race and insurance status were the socioeconomic factors most consistently associated with differences in management and outcomes.
Research significance
The review supports associations between socioeconomic factors and vestibular schwannoma care; it is reasonable—but untested—to hypothesize that interventions improving access, referral pathways, or treatment equity could improve outcomes, with no evidence here establishing such benefit or applicability to pediatric patients.
Source abstract
Disparities in neurosurgical care are increasingly recognized, yet how they affect the diagnosis and management of vestibular schwannoma (VS) remains unclear. Differences in tumor size at diagnosis, treatment selection, and outcomes may be influenced by race, insurance status, income, and geography. To date, no comprehensive synthesis has addressed these inequities in patients with sporadic VS. To systematically evaluate the literature for evidence of social determinants of health (SDoH) in the diagnosis, treatment, and outcomes of patients with sporadic vestibular schwannoma. We conducted a PRISMA-guided systematic review of PubMed, Embase, and Web of Science (2000-2024). Included studies examined adult patients with sporadic VS and reported at least one socioeconomic variable. Non-English studies and those involving pediatric patients were excluded. Studies focusing on neurofibromatosis type 2 were excluded. Screening and data extraction were conducted independently by multiple reviewers using Covidence. Outcomes of interest included tumor size, treatment modality (surgery, radiosurgery, observation), hearing preservation, complications, and recurrence. Study quality was assessed using the GRADE framework and evaluated across the domains of risk of bias, inconsistency, indirectness, imprecision, and publication bias. Of 487 records identified, 40 met inclusion criteria. Most were US-based, retrospective studies that utilized national databases for patient recruitment. Race and insurance status were the most frequently reported variables; income and geographic indicators were less commonly assessed. Outcomes described the likelihood of treatment received, including surgery or SRS, complications including morbidity and mortality, length of stay, and discharge disposition including rehab and readmission. Few studies assessed functional status (n=2), hearing outcomes (n=2), or quality of life (n=1). In total, 358,843 patients were included across the 40 studies analyzed. This review suggests that disparities in vestibular schwannoma care are multi-factorial, with race and insurance status showing the most consistent associations between management, outcomes, and disparities. As treatment continues to evolve and become more centralized, future work should prioritize multi-institutional studies to incorporate patient-level socioeconomic data and evaluate outcomes beyond management selection.