Impact of healthcare disparities on the treatment and survival of patients with high-grade gliomas in Colombia: a multicenter inverse probability-weighted cohort analysis

PURPOSE: Explore the impact of healthcare disparities in patients with high-grade glioma (HGG) in the Colombia's universal healthcare model setting, aiming to assess access to adjuvant treatment and survival outcomes among HGG patients covered under contributory versus subsidized insurance schemes in Bogotá, Colombia.

METHODS: A retrospective cohort study was conducted in two academic neurosurgical centers in Bogotá, Colombia, each serving patient populations with a differential distribution by insurance scheme. Adult patients with newly diagnosed high-grade glioma (HGG) who underwent surgical management between 2017 and 2021 were included. Patients with recurrent disease at presentation or lost to follow-up after surgery were excluded. Demographic, clinical, surgical, and treatment data were collected. The primary outcome was overall survival, assessed through medical records and the national death registry. A propensity score model with inverse probability of treatment weighting (IPTW) was used to adjust for confounding. Cox proportional hazards and logistic regression models were applied.

RESULTS: A total of 113 patients were included; 88 had contributory coverage and 25 had subsidized coverage. Patients in the subsidized group had significantly lower rates of postoperative medical oncology consultation (48% vs. 84%, 95% p < 0.001), chemotherapy (28% vs. 68.2%, p < 0.001), and radiotherapy (8% vs. 56.3%, p < 0.001). Median overall survival was significantly lower in the subsidized group (9.8 vs. 16.5 months, p = 0.006). After IPTW adjustment, subsidized insurance (HR 1.66, 95% CI 1.03-2.68, p = 0.035), subtotal resection (HR 1.58, 95% CI 1.01-2.49, p = 0.045), and lack of oncology consultation (HR 5.24, 95% CI 1.21-22.63, p = 0.026) were independently predicted worse survival. Female sex (OR 2.59, p = 0.045) and subsidized coverage (OR 8.21, p < 0.001) were associated with failure to complete oncology follow-up.

CONCLUSIONS: In the context of a universal healthcare system such as Colombia's, differences in access to adjuvant therapy may contribute to survival disparities among patients with high-grade gliomas. While formal insurance coverage is broadly available, it does not necessarily ensure timely or equitable care delivery. Additionally, our findings suggest that gender-related factors may influence access to postoperative oncology care. Efforts to strengthen care coordination, address structural barriers, and ensure equitable access across insurance types and sexes could help improve outcomes in this population.