The association of economic measures and patient outcomes with geographical disparities in access to a UCNS-certified neuro-oncologist in the United States.
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BACKGROUND AND OBJECTIVES: Neuro-oncology is increasingly centralized in academic tertiary centers, potentially creating geographic and economic inequities. This study aims to quantify the national distribution of neuro-oncologists and evaluates the association between regional economic capacity, metropolitan urbanicity and population-level clinical outcomes. METHODS: We conducted a nationwide cross-sectional ecological analysis using 2025 United Council for Neurologic Subspecialties (UCNS) data, US Bureau of Economic Analysis state-level GDP, and US Census Bureau demographics. Geographic proximity was modeled for US counties using geodesic distance from population centroids. Outcome measures included CNS tumor mortality and Disability-Adjusted Life Years (DALYs). RESULTS: We identified 323 UCNS-certified neuro-oncologists. Workforce distribution was strongly associated with state-level economic magnitude (r = 0.930 [95% CI: 0.878-0.960], p < 0.0001), with GDP explaining 86.4% of variance (R2=0.864). Specialists were located exclusively within metropolitan statistical areas (MSAs), however 81.1% of MSAs lacked local subspecialty presence. Spatial analysis revealed 45.4% of the US population resides < 20 miles from the nearest neuro-oncologist, while 16.5% live in "Care Deserts" (>100 miles). Lower specialist density was ecologically correlated with higher mortality rates for pediatric (ρ = -0.34 [95% CI: -0.57 to -0.06], p = 0.015) and adult (ρ = -0.352 [95% CI: -0.57 to -0.07], p = 0.011) groups. Similar inverse associations were observed for DALYs in both pediatric (ρ=-0.339) and adult (ρ=-0.347) populations. DISCUSSION: Neuro-oncology workforce distribution is associated with state-level economic magnitude. However, sensitivity analyses suggest this association is partly attributable to population scale and infrastructure concentration rather than regional affluence per se. Lower specialist density was ecologically associated with higher CNS tumor mortality and DALYs in underserved regions. POLICY SUMMARY: Addressing these structural inequities requires systemic interventions, including telemedicine and decentralized care models.