Does socioeconomic status account for racial and ethnic disparities in childhood cancer survival?

Kehm, Rebecca D.; Spector, Logan G.; Poynter, Jenny N.; Vock, David M.; Altekruse, Sean F.; Osypuk, Theresa L.

doi:10.1002/cncr.31560

Cited by 121 publications

(155 citation statements)

References 28 publications

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“…Some groups of minority patients are also less likely to be enrolled in clinical trials, which might contribute to worse survival . While lower socioeconomic position has been associated with higher mortality in some, but not all studies, our study illustrated racial and ethnic differences in survival within the same economic status (Table ).…”

Section: Discussionmentioning

confidence: 53%

Racial and ethnic differences in survival of pediatric patients with brain and central nervous system cancer in the United States

Siegel

Ding³

et al. 2018

Pediatric Blood & Cancer

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Background Brain and central nervous system (CNS) cancer is the leading cause of cancer death among children and adolescents in the United States. Data from earlier studies suggested racial and ethnic differences in survival among pediatric patients with brain tumor. This study examined racial/ethnic difference in survival using national data and considered the effects of demographic and clinical factors. Methods Using National Program of Cancer Registries data, 1‐, 3‐, and 5‐year relative survival (cancer survival in the absence of other causes of death) was calculated for patients with brain and CNS cancer aged < 20 years diagnosed during 2001–2008 and followed up through 2013. Racial and ethnic differences in survival were measured by sex, age, economic status, stage, anatomic location, and histology. Adjusted racial and ethnic difference in 5‐year cancer specific survival was estimated using multivariable Cox regression analysis. Results Using data from 11 302 patients, 5‐year relative survival was 77.6% for non‐Hispanic white patients, 69.8% for non‐Hispanic black patients, and 72.9% for Hispanic patients. Differences in relative survival by race/ethnicity existed within all demographic groups. Based on multivariable analysis, non‐Hispanic black patients had a higher risk of death at 5 years after diagnosis compared to non‐Hispanic white patients (adjusted hazard ratio = 1.2, 95% confidence interval, 1.1–1.4). Conclusions Pediatric brain and CNS cancer survival differed by race/ethnicity, with non‐Hispanic black patients having a higher risk of death than non‐Hispanic white patients. Future investigation of access to care, social and economic barriers, and host genetic factors might identify reasons for disparities in survival.

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Section: Discussionmentioning

confidence: 53%

Racial and ethnic differences in survival of pediatric patients with brain and central nervous system cancer in the United States

Siegel

Ding³

et al. 2018

Pediatric Blood & Cancer

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“…When observing immigrant children in Europe overall, higher morbidity and mortality has been seen to be associated with the minority status of immigrant children and their low socioeconomic status . In the United States, socioeconomic status has been shown to mediate racial/ethnic childhood cancer survival disparities for several cancers . The setting in the United States and Finland is not entirely comparable due to a differently structured health care system, with childhood cancer patients in Finland being solely treated in public sector hospitals.…”

Section: Discussionmentioning

confidence: 99%

Childhood cancer mortality and survival in immigrants: A population‐based registry study in Finland

Kyrönlahti

Madanat‐Harjuoja

Pitkäniemi

et al. 2019

Intl Journal of Cancer

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Immigration in Europe has increased considerably over the past decades with the immigrant population similarly expanding in Finland. Our aim was to study childhood cancer mortality and survival in immigrants. In all, 4,437 patients diagnosed with cancer under the age of 20 years between 1990 and 2009 were identified from the Finnish Cancer Registry and their parents from the Population Register Center. Information on demographic factors was obtained from Statistics Finland. Poisson regression modeling was used to estimate hazard ratios (HRs) for cancer deaths. The life table method and the log rank test were used in survival analysis. Patients or parents of foreign background and born abroad had higher 5‐year mortality (patient HR 2.03, 95% CI 1.18–3.49; maternal HR 2.11, 95% CI 1.46–3.04; paternal HR 1.85, 95% CI 1.29–2.66) compared to those of Finnish background and born in Finland. Childhood cancer survival in 5‐year follow‐up was higher if the mother (83% vs. 68%) or the father (83% vs. 70%) were of Finnish background and born in Finland. Despite equal access to public health care, we observed significant differences in childhood cancer mortality and survival by background. Cultural differences, linguistic obstacles and difficulties in navigating the health care system may contribute, along with genetic and biologic factors. Offering tailored information and taking cultural and linguistic aspects into account is necessary when diagnosing and treating patients from different ethnic backgrounds who have not yet integrated into the local culture and health care system.

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“…Survival differences by race/ethnicity among females diagnosed with ovarian GCTs have also been reported . A recent study shows that among children and adolescents diagnosed with a GCT, Hispanic children have higher all‐cause mortality than non‐Hispanic black or white children . Less is known about racial/ethnic differences in survival after a GCT diagnosis when males and females are considered separately, which is important as there are established differences in GCT survival by sex …”

Section: Introductionmentioning

confidence: 99%

“…3 A recent study shows that among children and adolescents diagnosed with a GCT, Hispanic children have higher all-cause mortality than non-Hispanic black or white children. 4 Less is known about racial/ethnic differences in survival after a GCT diagnosis when males and females are considered separately, which is important as there are established differences in GCT survival by sex. 5,6 GCTs are heterogeneous with regard to both tumor location and histology, which vary by sex, age at diagnosis and race/ethnicity and also impact survival.…”

Section: Introductionmentioning

confidence: 99%

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Survival differences by race/ethnicity among children and adolescents diagnosed with germ cell tumors

Williams

Frazier

Poynter

2019

Intl Journal of Cancer

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Survival differences by racial and ethnic group have been reported in children and adolescents with germ cell tumors (GCTs), but whether these differences depend on stage of disease is unclear. Using the SEER 18 registries (2000–2015), we examined GCT survival differences by race/ethnicity (non‐Hispanic white [NHW], Black, Asian/Pacific Islander [API], Hispanic) separately for males and females aged 0–19 years at diagnosis. We used Kaplan–Meier survival curves (Log‐Rank p values) to characterize survival differences. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between race/ethnicity and death. Using an inverse odds weighting mediation analysis, we estimated the association between race/ethnicity and death treating stage of disease as the mediator. There were no significant racial/ethnic survival differences among females. Male survival differed by race/ethnicity (p < 0.0001) with NHW males having the best survival. Compared to NHW, API and Hispanic males had significantly higher risks of death (API HR: 2.18; 95% CI: 1.32–3.56; Hispanic HR: 1.98; 95% CI: 1.42–2.78) (model adjusted for age and year at diagnosis, tumor histology and location, stage). This association was mediated by stage of disease only among Hispanic males with gonadal tumors (indirect HR: 1.18; 95% CI: 1.03–1.35). The increased risk of death after a testicular GCT diagnosis observed among Hispanic males was mediated by stage of disease. For API males and Hispanic males with extragonadal tumors, other unidentified factors including differences in exposures, tumor biology or treatment received may impact the observed racial/ethnic survival disparities.

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Does socioeconomic status account for racial and ethnic disparities in childhood cancer survival?

Cited by 121 publications

References 28 publications

Racial and ethnic differences in survival of pediatric patients with brain and central nervous system cancer in the United States

Racial and ethnic differences in survival of pediatric patients with brain and central nervous system cancer in the United States

Childhood cancer mortality and survival in immigrants: A population‐based registry study in Finland

Survival differences by race/ethnicity among children and adolescents diagnosed with germ cell tumors

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