Population-Based Analysis of Demographic and Socioeconomic Disparities in Pediatric CNS Cancer Survival in the United States

Abstract

Previous studies have demonstrated effects of racial and socioeconomic factors on survival of adults with cancer. While less studied in the pediatric population, data exist demonstrating disparities of care and survival in pediatric oncology patients based on socioeconomic and racial/ethnic factors. Brain cancers recently overtook leukemia as the number one cause of childhood cancer fatalities, but demographic and socioeconomic disparities in these tumors have not been adequately studied. We obtained data from the SeeR program of the national cancer institute (nci). We selected patients under 19 years of age with central nervous system (CNS) cancers diagnosed between 2000 and 2015. We included patient demographics, tumor characteristics, treatment, and socioeconomic characteristics as covariates in the analysis. We measured overall survival and extent of disease at diagnosis. We saw that Black and Hispanic patients overall had a higher risk of death than non-Hispanic White patients on multivariable analysis. On stratified analysis, Black and Hispanic patients with both metastatic and localized disease at diagnosis had a higher risk of death compared to White, non-Hispanic patients, although the difference in Black patients was not significant after adjusting for mediating factors. However, our findings on extent of disease at diagnosis demonstrated that neither Black race nor Hispanic ethnicity increased the chance of metastatic disease at presentation when controlling for mediating variables. In summary, racial and ethnic disparities in childhood CNS tumor survival appear to have their roots at least partially in post-diagnosis factors, potentially due to the lack of access to high quality care, leading to poorer overall outcomes.

Minority children experience a higher risk of death from many central nervous system tumor types even after accounting for treatment received: A National Cancer Database analysis

“…In our study of 22,469 brain and CNS tumors diagnosed in children aged 0 to 19 years and captured in the NCDB (2004-2016), we found overall and histologyspecific differences in survival by race/ethnicity such that Black and Hispanic children had worse survival than White children. The findings for Black children experiencing a higher risk of death align with previous publications 4 and with a recent report by Siegel et al 3 using National Cancer Registry data, who observed a 24% excess in death among Black patients, which was similar to our estimate of a 22% excess. However, they did not observe an excess risk of death among Hispanic patients in their study as we did herein.…”

“…Brain tumors are the most common solid tumors in children 1 . Minority children are less frequently diagnosed with these tumors as White children have an incidence rate of 5 cases per 100,000 and Black and Hispanic children have a rate of 4 cases per 100,000 2 ; however, Black and Hispanic children experience an increased risk of death in comparison with White children 3,4 even after accounting for age, socioeconomic status, stage of disease, and treatment as adjustment factors in the analysis 5 . Often times, racial/ethnic survival disparities are explained by or linked to existing differences in socioeconomic status 6 .…”

Race, Zoonoses and Animal Assisted Interventions in Pediatric Cancer

“…Despite similar reported survival rates for Hispanics, African Americans, Asians and White children, gaps in understanding disparities in cancer still exist [26,27]. Racial and ethnic disparities in childhood CNS tumor survival appear to have their roots at least partially in post-diagnosis factors, potentially due to the lack of access to high quality care, leading to poorer overall outcomes [28,29]. These disparities include differences or delays in treatment.…”

“…Additional disparities include impaired access to care and clinical trials, differences in cancer biology, treatment non-adherence, language barriers, and implicit racial bias. Although socioeconomic factors may account for a large proportion of disparities seen, the causes of disparities are complex and interconnected and still need to be better understood [27,28]. Further studies on how systemic racism and oppression impact pediatric cancer are needed.…”

Neighborhood Socioeconomic Deprivation and Mortality in Children with Central Nervous System Tumors

“…Despite the improvement in the prognosis of brain tumors achieved by incorporating advanced surgical technologies and knowledge in molecular classification (2), the factors associated with differential survival are still unclear. An important set of factors and a persistent public health concern are inequalities by sociodemographic characteristics in access to general health care, neurosurgical, and neuro-oncological (3)(4)(5).…”