# The Association of Neighborhood-Level Deprivation with Glioblastoma Outcomes: A Single Center Cohort Study

## TL;DR

This study shows that people with glioblastoma living in more deprived neighborhoods have worse survival outcomes, even after accounting for other factors.

## Contribution

This is the first study to demonstrate the impact of neighborhood deprivation on glioblastoma survival while controlling for socioeconomic and biomolecular markers.

## Key findings

- Patients in high deprivation neighborhoods had significantly worse overall survival (11.7 vs 14.8 months).
- High ADI was associated with worse survival in multivariable analysis (HR 1.25, 95%CI 1.09–1.43).
- Findings were consistent in a subgroup diagnosed after 2017 (HR 1.26, 95%CI 1.01–1.56).

## Abstract

Glioblastoma is the most common primary brain malignancy. Though literature has suggested the association of glioblastoma outcomes and socioeconomic status, there is limited evidence regarding the association of neighborhood-level socioeconomic deprivation on glioblastoma outcomes. The aim of this study was to assess the impact of neighborhood-level socioeconomic deprivation on glioblastoma survival.

We retrospectively reviewed all adult glioblastoma patients seen at a single institution from 2008 to 2023. Neighborhood deprivation was assessed via Area Deprivation Index (ADI), with higher ADI indicating greater neighborhood socioeconomic deprivation. Log-rank tests and multivariate cox regression was used to assess the effect of ADI and other socioeconomic variables while controlling for a priori selected clinical variables with known relevance to survival.

In total, 1464 patients met inclusion criteria. The average age at diagnosis was 60 ± 14 years with a median overall survival of 13.8 months (IQR 13–14.8). The median ADI of the cohort was 66(IQR 46–84). Patients with high ADI had worse overall survival compared to patients with low ADI (11.7 vs 14.8 months, p=.001). In the multivariable model, patients with high ADI had worse overall survival (HR 1.25, 95%CI 1.09–1.43). To account for changes in WHO guidelines, we implemented the model on patients diagnosed between 2017–2023 and findings were consistent (HR 1.26,95%CI 1.01–1.56).

We report the first study demonstrating glioblastoma patients with higher neighborhood deprivation have worse survival after controlling for other socioeconomic and biomolecular markers. Neighborhood socioeconomic status may be a prognostic marker for glioblastoma survival.