Socioeconomic Disparities in Patient-Reported Outcomes, Health Literacy, and Access to Care Among Patients With Primary Brain Tumors: Findings From the All of Us Research Program

Purpose To understand the impact of socioeconomic status (SES) on patient-reported outcomes, health literacy, and access to care in primary malignant brain tumors (PMBT). Methods We performed a retrospective analysis of adults with PMBT using the NIH All of Us Program database. Patients were stratified into low (<$50,000), middle ($50,000–$100,000), and high (>$100,000) income groups. Outcomes on self-reported symptom burden, health status, health literacy, and barriers to healthcare access were compared. Results Of 1,095 PMBT patients in the database, 883 took surveys after diagnosis. Across these patients higher SES was associated with greater educational attainment, employment, homeownership, and marriage rates (all p < 0.001). Lower SES participants reported higher rates of moderate-to-severe fatigue (p < 0.001), greater pain (p < 0.001), and more frequent feelings of anxiety, depression, and irritability (p = 0.002). Quality of life ratings were significantly higher among high SES participants (p < 0.001). Low SES patients reporting less confidence filling out medical forms, more assistance filling out health materials, and more difficulty understanding presented written healthcare material (p < 0.001). Low SES group also had more experience with delays in prescription, trouble affording dental care, skipped medications to save money, worry about paying medical bulls, and inability to afford co-pays (p < 0.05). Conclusions SES significantly influences patient-reported outcomes, health literacy, and financial barriers in individuals with PMBT. These findings extend prior evidence linking SES to treatment access and survival, underscoring the need for targeted interventions that address health literacy, financial toxicity, and supportive care in addition to equitable access to treatment.