Date of Award

January 2023

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Elizabeth Claus

Abstract

PURPOSE: It is unclear what role sociodemographic predictors have on the subtype-specific survival patterns of patients with low-grade gliomas. Understanding these effects may help guide and improve public health intervention strategies for patients with this relatively rare, understudied condition. METHODS: Using the Surveillance, Epidemiology, and End Results Program, we identified adult cases (aged 20-79 years) diagnosed with a World Health Organization Central Nervous System grade II supratentorial astrocytoma, oligodendroglioma, or mixed glioma between 1975-2019. Kaplan-Meier estimates and multivariable Cox models were utilized to assess factors associated with survival. RESULTS: The final cohort included 4,684 adult grade II glioma cases with a median survival of 5.7 (95% confidence interval [CI]: 5.3-6.1) years. Approximately 10% of patients diagnosed in 1975-1994 survived at least 25 years. The median survival for oligodendroglioma, mixed glioma, and astrocytoma patients was 13.7 (95% CI: 12.7-14.9), 9.3 (95% CI: 7.9-10.5), and 2.5 (95% CI: 2.3-2.8) years, respectively (log-rank p <0.01). In the multivariable model, oligodendroglioma cases had better survival than astrocytoma cases (hazard ratio [HR]=0.40, 95% CI: 0.34-0.46, p<0.01). Men had a 17% (95% CI: 1.04,1.31, p=0.01) increased risk of death relative to women. Astrocytoma patients residing in metropolitan areas had a lower risk of death than non-metropolitan residents (HR=0.77, 95% CI: 0.60-0.98, p=0.03). Among patients with mixed glioma, divorced or separated patients had inferior survival than their married counterparts (HR=2.97, 95% CI: 1.28-6.91, p<0.01). CONCLUSIONS: Altogether, our findings indicate that the effects of demographic factors on low-grade glioma survival vary by subtype, and that further work is required to explain these associations.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/10/2024

Download

Share

COinS