Abstract
AIMS: Despite advances in surgical and therapeutic strategies, survival outcomes for high-grade gliomas (HGG) remain stagnant. Socioeconomic status (SES) is a well-established determinant of cancer outcomes, yet its influence on HGG survival remains poorly understood. This analysis aims to comprehensively evaluate the impact of SES on HGG survival, synthesising existing evidence to optimise patient pathways and promote equitable oncological care. METHODS: A systematic search of Embase, Medline, Scopus, and Web of Science was completed on 10th February 2024. Studies examining the relationship between socioeconomic factors and survival outcomes in HGG were in- cluded. Two reviewers independently performed screening, data extraction, and quality assessment. Meta- analysis was conducted for studies reporting hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: Out of 5,681 screened studies, 52 met the inclusion criteria including assessment of education (n=12), employ- ment (n=4), income (n=22), and insurance status (n=23), along with other aggregated SES measures. 75% of stud- ies found higher education levels significantly associated with improved survival. Employment status strongly influenced outcomes, with part-time workers, unemployed, and retired individuals experiencing worse sur- vival compared to full-time workers (HR=1.86; 95% CI 1.18–2.94; I²=50%; p=0.007). 68% of studies reported that higher annual income correlated with improved survival, although a subgroup analysis found no statistically significant difference between insured and uninsured patients (p>0.05). CONCLUSION: Employment status is a significant predictor of survival in HGG, with education and income also linked to better outcomes in several studies. Despite methodological inconsistencies, heterogeneous SES measures, and health- care system variations, the evidence suggests that SES influences HGG survival. Future research should stan- dardise SES assessments and leverage larger, more consistent cohorts to clarify and strengthen these findings.