Diversifying the CNS and AANS: A Pathway to Improving Patient Care

W. Christopher Newman, MD | Maryam Rahman, MD, FAANS | Garni Barkhoudarian, MD, FAANS | September, 2021

The past two years of the COVID-19 pandemic have brought the impact of socioeconomic disparity on health outcomes to the forefront of national attention. The pandemic laid bare the disparate access to medical care felt by those at the lowest rungs of the American socioeconomic ladder and the deadly influence social determinants of health can have on clinical outcomes.1 The World Health Organization defines social determinants of health as non-medical factors that influence health outcomes. These factors include all of the conditions into which people are born and in which they live, such as race, sex, education, food access, income and many more.2 In many cases, these social determinants of health can have seemingly outsized effects on outcomes.

In this setting, there has been a renewed interest within many fields, including neurosurgery, to examine the impact of social determinants of health on patient outcomes in order to determine how to ameliorate their detrimental impact. Within the field of neurosurgical oncology, these efforts primarily have included large, retrospective database studies to identify trends and associations between social determinants of health and patient outcomes for these relatively less common diagnoses. Across numerous studies, the results consistently have demonstrated a detrimental impact of social determinants of health on patient outcomes, but variably agreed on the relative import of each individual factor.3–5 In neurosurgical oncology, the findings are similarly mixed, but the impact of socioeconomic disparities may be felt more strongly due to the chronic nature of many of these diseases. While an oncologic surgery may take a single day to perform, there typically are years of follow-up, repeat operations, adjuvant therapy, and ongoing care that can compound the impact of socioeconomic disparities by dispersing their impact over time.

If we as a field can agree that social determinants of health have a substantial impact on patient outcomes, then we should also be able to agree that mitigating these impacts is of paramount importance; no patient’s outcome should be determined by the city in which they live, the job in which they work, their gender, or the color of their skin. However, history has shown us that meaningful, long-term, systemic changes to healthcare access and delivery can take years, if not decades, to realize. What, then, may be done on a smaller, more immediate, more direct scale to incite change in the short-term?

As a first step we should strive to diversify representation within all echelons of neurosurgery. Studies have shown that diversifying healthcare at all levels leads to improved patient compliance, more uniform delivery of healthcare services, lower healthcare costs, and better patient outcomes.6 These studies and those in other fields clearly show that the diversity of thought that arises through the diversity of experience elevates the work that we do on all levels. To this end, the CNS and AANS have created a committee for equity, diversity, and inclusion to build a framework within which diversity of thought, experience, and background can be advanced. The goal of this committee is to help ensure that neurosurgeons at all stages of their careers and from a variety of backgrounds and practice models have the opportunity to meaningfully participate in organized neurosurgery.

By giving members increased opportunities to participate, we are giving ourselves the best possible opportunity to learn from voices that previously may not have been heard. Increasing diversity in organized neurosurgery is the rising tide that can begin to elevate all of us and by making our own system more diverse, we are working towards contributing to the equity of the entire healthcare system. While we may not be able to overhaul the entire healthcare system in a day, a month, or even years, these small, significant changes that we can make today to diversify our field can be the catalyst for better care for our patients.

Citations

  1. Rossen LM. Disparities in Excess Mortality Associated with COVID-19 — United States, 2020. MMWR Morb Mortal Wkly Rep. 2021;70. doi:10.15585/mmwr.mm7033a2
  2. Social determinants of health. Accessed August 30, 2021. https://www.who.int/westernpacific/health-topics/social-determinants-of-health
  3. Glauser G, Detchou DK, Dimentberg R, Ramayya AG, Malhotra NR. Social Determinants of Health and Neurosurgical Outcomes: Current State and Future Directions. Neurosurgery. 2021;88(5):E383-E390. doi:10.1093/neuros/nyab030
  4. Curry WT, Carter BS, Barker FG. Racial, ethnic, and socioeconomic disparities in patient outcomes after craniotomy for tumor in adult patients in the United States, 1988-2004. Neurosurgery. 2010;66(3):427-437; discussion 437-438. doi:10.1227/01.NEU.0000365265.10141.8E
  5. Elder T, Ejikeme T, Felton P, et al. Association of Race with Survival in Intracranial World Health Organization Grade II and III Meningioma in the United States: Systematic Literature Review. World Neurosurg. 2020;138:e361-e369. doi:10.1016/j.wneu.2020.02.120
  6. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383-392. doi:10.1016/j.jnma.2019.01.006