Race, ethnicity, and socioeconomic differences in incidence of pediatric embryonal tumors in the United States

Abstract

Background The etiology of childhood cancers and its social patterning remains largely unknown. Accounting for socioeconomic status (SES) when exploring the association between race/ethnicity and cancer incidence is necessary to better understand such etiology. We aimed to investigate differences in the incidence of embryonal tumors (ETs) by SES and race/ethnicity in the United States using population‐based registries of the Surveillance, Epidemiology, and End Results (SEER) Program. Procedure Children with ETs aged 0‐19 years diagnosed between 2000 and 2015 were ascertained from the census tract‐level SEER database. SES was measured using a tract‐level composite index. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) by SES quintile and race/ethnicity were estimated using multivariable Poisson regression models. Results The majority of tumors had lower incidence among nonwhite children compared with non‐Hispanic (NH) white children, after controlling for SES. NH blacks had a higher incidence of Wilms tumor than NH whites (IRR: 1.26; 95% CI, 1.13‐1.39). There was an increasing linear trend (P = 0.0001) across increasing SES quintile for embryonal rhabdomyosarcoma after controlling for race/ethnicity. Effect modification by race/ethnicity of the relationship between SES and tumor incidence was observed for several groups. Hispanics had a significant, linear trend (P = 0.0005) in the incidence of Wilms tumor, while Asian/Pacific Islanders experienced a significant inverse trend (P = 0.0002). Conclusions Results from this study suggest differences in the incidence of several ETs by race/ethnicity and that these differences may be modified by SES. Investigation of potential risk factors that are socially patterned is warranted.

Racial and ethnic disparities in pediatric cancer incidence among children and young adults in the United States by single year of age

“…By contrast, a recent analysis of racial and ethnic differences in embryonal tumor incidence suggested that these may be modified by socioeconomic status. 50 Finally, although we were not able to account for birth characteristics and other exposures that may be associated with race and ethnicity, our overall IRR estimates are similar to those reported previously. 3 Thus, it is likely that genetic variants contribute to the racial and ethnic differences risk of many cancers, but the degree to which differences are explained by genetics may vary by tumor type.…”

“…Although the incidence of acute lymphoblastic leukemia rose with increasing socioeconomic status among Black children, at all levels their rate was substantially lower than that in White children. By contrast, a recent analysis of racial and ethnic differences in embryonal tumor incidence suggested that these may be modified by socioeconomic status 50 . Finally, although we were not able to account for birth characteristics and other exposures that may be associated with race and ethnicity, our overall IRR estimates are similar to those reported previously 3 .…”

Exploration of genetic ancestry and socioeconomic status in the incidence of neuroblastoma: An ecological study

“…Previous studies demonstrated that some minority groups have a higher risk of neuroblastoma. 7,8,20 may not accurately represent the risk susceptibility between different ancestries. 45,52 Further study is warranted to verify whether the effect size of GWAS SNPs differs between populations and whether there are ancestry-specific genetic variants.…”

“…We found no significant associations, but we would be remiss if we did not mention the limitations of the data. Previous studies demonstrated that some minority groups have a higher risk of neuroblastoma 7,8,20 . Because the CI5 data do not break down populations by race/ethnicity, we used the limited information to categorize populations into predominant ancestry.…”

“…18 It is unclear whether underdiagnosis in developing countries is the main driver for such correlation. 19 However, given that socioeconomic status can modify the relationship between race/ethnicity and the incidence of pediatric embryonal tumors, 20 it is reasonable to consider socioeconomic status as a confounder in the relationship between ancestry-specific genetic predisposition and the incidence of neuroblastoma in order to reveal the etiology of neuroblastoma.…”