Social determinants of health affecting treatment of pediatric brain tumors

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Little is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors conducted a retrospective study of pediatric patients (&lt; 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p &lt; 0.05.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p &lt; 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>No significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.</jats:p></jats:sec>

Evaluating palliative opportunities in pediatric patients with leukemia and lymphoma

“…When the disease course was divided into temporal quartiles, palliative opportunities increased toward the EOL, with a median of 1.0 (IQR 1.0), 0.0 (IQR 1.0), 0.0 (IQR 2.0), and 2.5 (IQR 4.0) palliative opportunities during the first, second, third, and fourth quartiles, respectively. As race, ethnicity, social determinants of health, and Medicaid insurance have been associated with symptom burden, PC consultation, and EOL outcomes in prior adult and pediatric oncology studies, demographics were assessed in relation to palliative opportunities 35–39 . The total number of palliative opportunities did not differ by sex ( p = 0.12), race ( p = 0.75), ethnicity ( p = 0.61), age at diagnosis ( p = 0.67), primary language ( p = 0.68), primary insurer ( p = 0.84), or primary cancer diagnosis ( p = 0.46).…”

Racial/ethnic, socioeconomic, and geographic survival disparities in adolescents and young adults with primary central nervous system tumors

“…Decreased access to clinical trials as well as the complicated multidisciplinary management of these patients may also help explain survival disparities 30,38,39 . Racial/ethnic minority patients and patients with low SES may also be more prone to loss to follow up due to a range of social barriers, including inherent distrust of the healthcare system fostered by experiences of discrimination 40,41 . Additionally, there remains a disparity in insurance coverage amongst patients from racial/ethnic minorities despite the Affordable Care Act 42 …”

“…30,38,39 Racial/ethnic minority patients and patients with low SES may also be more prone to loss to follow up due to a range of social barriers, including inherent distrust of the healthcare system fostered by experiences of discrimination. 40,41 Additionally, there remains a disparity in insurance coverage amongst patients from racial/ethnic minorities despite the Affordable Care Act. 42 Similarly, geography affects the ability to expediently access necessary care.…”

Financial risk protection for neurosurgical care in Indonesia and the Philippines: a primer on health financing for the global neurosurgeon

“…Few studies have examined the association between patient-level socioeconomic factors and outcomes across the various diseases that are treated by the specialty of neurosurgery-pediatric hydrocephalus (6, 7, 8), craniosynostosis (9), intracranial tumors (10,11,12,13), aneurysmal subarachnoid hemorrhage (14,15) and stroke (16, 17), traumatic brain injury (18, 19), spine disorders (20) and spinal cord injury (21,22). Many of these studies describe the more frequently unfavorable outcomes among the inadequately insured and those with lower socioeconomic status.…”