Racial and ethnic disparities in survival of children with brain and central nervous tumors in the United States

Abstract

Background: Despite improvements in overall survival for pediatric cancers, treatment disparities remain for racial/ethnic minorities compared to non-Hispanic Whites; however, the impact of race on treatment outcomes for pediatric brain and central nervous system (CNS) tumors in the United States is not well known. Methods: We included 8713 children aged 0-19 years with newly diagnosed primary brain and CNS tumors between 2000 and 2015 from the Census Tract-level SES and Rurality Database developed by Surveillance, Epidemiology, and End Results (SEER) Program. We used chi-square tests to assess differences in sociodemographic, cancer, and treatment characteristics by race/ethnicity and Kaplan-Meier curves and Cox proportional hazards models to examine differences in 10-year survival, adjusting for these characteristics. Results: Among 8713 patients, 56.75% were non-Hispanic White, 9.59% non-Hispanic Black, 25.46% Hispanic, and 8.19% from "other" racial/ethnic groups. Median unadjusted survival for all pediatric brain tumors was 53 months, but varied significantly by race/ethnicity with a median survival of 62 months for non-Hispanic Whites, 41 months for non-Hispanic Blacks, and 40 months for Hispanic and other. Multivariable analyses demonstrated minority racial groups still had significantly higher hazard of death than non-Hispanic Whites; Hispanic (adjusted hazard ratio [aHR] 1.25 [1.18-1.31]); non-Hispanic Black (aHR 1.12 [1.04-1.21]); other (aHR 1.22 [1.12-1.32]). Results were consistent when stratified by tumor histology. Conclusion: We identified disparities in survival among racial/ethnic minorities with pediatric brain and CNS tumors, with Hispanic patients having the highest risk of mortality. Eliminating these disparities requires commitment toward promoting heath equity and personalized cancer treatment.

Burden and trends of brain and central nervous system cancer from 1990 to 2019 at the global, regional, and country levels

“…Updated epidemiological data on the burden of brain and CNS cancers is thus required. However, there are few reports on the epidemiology of brain and CNS cancers in all age groups [14][15][16]. Some studies have focused only on the incidence and mortality of brain and CNS tumors in children, while ignoring incidence and mortality in elderly patients.…”

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

“…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 However, in a mediation analysis examining the role of socioeconomic status between race/ethnicity and survival from childhood cancers, 7 most of the observed associations were only minimally explained by, or were largely independent of, socioeconomic status, and strong direct effects of race/ethnicity were observed.…”

“…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 .…”

Incidence and 5‐year survival of children and adolescents with hepatoblastoma in the United States

“…1,8,9 The COG AHEP0731 study We identify that in the survival of patients with HB, racial and ethnic disparities exist, which have not been previously described, but have been observed with other cancers, including hepatocellular carcinomas, brain and central nervous system tumors, leukemias, and lymphomas. [29][30][31][32] Specifically, we found that NH Black race or ethnicity was a significant risk marker of reduced overall survival in multivariable Cox regression analysis. Race or ethnicity overall was not found the model.…”