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

Williams, Lindsay A.; Frazier, A. Lindsay; Poynter, Jenny N.

doi:10.1002/ijc.32569

Cited by 17 publications

(21 citation statements)

References 38 publications

(89 reference statements)

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“…26 The model without the IOWs yielded the total effect (β total ) and the model with the IOWs yielded the direct effect (β direct ). 26 The indirect effect (effect of race/ethnicity on hazard of death mediated by SES) was calculated by subtracting the direct effect from the total effect. 26 If the p-value calculated for β indirect was statistically significant, mediation effect of SES on race/ethnicity associated with hazard of death was concluded to exist.…”

Section: Discussionmentioning

confidence: 99%

“…26 The indirect effect (effect of race/ethnicity on hazard of death mediated by SES) was calculated by subtracting the direct effect from the total effect. 26 If the p-value calculated for β indirect was statistically significant, mediation effect of SES on race/ethnicity associated with hazard of death was concluded to exist. Note that 95% confidence intervals (CIs) for β total , β direct, and β indirect were estimated using bootstrapping .…”

Section: Discussionmentioning

confidence: 99%

“…The weight for race/ethnicity was obtained from a multivariate logistic regression model. For each racial/ethnic group, two multivariate Cox proportional hazards were then calculated, one without the IOWs and one with IOWs 26 . The model without the IOWs yielded the total effect (β total ) and the model with the IOWs yielded the direct effect (β direct ) 26 .…”

Section: Methodsmentioning

confidence: 99%

“…For each racial/ethnic group, two multivariate Cox proportional hazards were then calculated, one without the IOWs and one with IOWs 26 . The model without the IOWs yielded the total effect (β total ) and the model with the IOWs yielded the direct effect (β direct ) 26 . The indirect effect (effect of race/ethnicity on hazard of death mediated by SES) was calculated by subtracting the direct effect from the total effect 26 .…”

Section: Methodsmentioning

confidence: 99%

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

Puthenpura

Canavan²,

Poynter

et al. 2021

Pediatric Blood & Cancer

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Background: Disparities in survival by race/ethnicity, socioeconomic status (SES), and geography in adolescent and young adult (AYA) patients with central nervous system (CNS) tumors have not been well studied.Procedure: A retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER) database was conducted for AYA patients diagnosed with primary CNS tumors. Adjusted hazard ratios (aHR) were calculated using a multivariate Cox proportional hazard model to evaluate the association between race/ethnicity, SES, rurality, and hazard of death.Results: All minority groups showed an increased hazard of death with greatest disparities in the high-grade glioma cohort. Lower SES was associated with an increased hazard of death in non-Hispanic White (NHW) patients (aHR 1.12; 95% confidence interval [CI] 1.01-1.24), non-Hispanic Black (NHB) patients (aHR 1.34; 95% CI 1.00-1.80), and patients aged 25-29 years (aHR 1.29; 95% CI 1.07-1.55). Mediation analysis showed an indirect effect of SES on the effect of race/ethnicity on the hazard of death only among NHB patients, with SES accounting for 33.7% of the association between NHB and hazard of death. Rurality was associated with an increased hazard of death for patients in the lowest SES tertile (aHR 1.31; 95% CI 1.08-1.59) and NHW patients (aHR 1.20; 95% CI 1.08-1.34). Conclusions:Patients identified as a racial/ethnic minority, patients with a lower SES, and patients residing in rural areas had an increased hazard of death. Further studies are needed to understand and address the biological, psychosocial, societal, and economic factors that impact AYA neuro-oncology patients at highest risk of experiencing poorer outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Puthenpura

Canavan²,

Poynter

et al. 2021

Pediatric Blood & Cancer

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“…19 In our data set, education level of parent and zip code were included as surrogate variables for SES. 20 Race and ethnicity have been studied as predictors of overall survival in various pediatric cancers, 21,22 QOL of children with leukemia, 23 experiences in end-of-life care, 24 and QOL of childhood cancer survivors. 25 Less is known of SES as a predictor of QOL in children in early treatment for any type of cancer.…”

Section: Introductionmentioning

confidence: 99%

Associations between Demographics and Quality of Life in Children in the First Year of Cancer Treatment

Raybin

Hendricks-Ferguson

Cook

et al. 2021

Preprint

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Symptom distress and decreased quality of life (QOL) among children with cancer are well documented. Research is emerging on the child’s voice in QOL-symptom reports, but existing QOL questionnaires are burdensome and objective biologic markers are lacking. We examined children’s symptoms and QOL from parent and child perspectives and compared the results to one biologic marker (body posture). A cross-sectional secondary analysis of prospective data from children receiving creative arts therapy explored potential associations among demographics with and between QOL measures (PedsQL, Faces Scale, posture). Children (n = 98) ranged in age from 3-17 years (M = 7.8) and were in the first year of cancer treatment. No significant associations were found among the child’s sex, race/ethnicity, socioeconomic status (SES), or distance from hospital and total PedsQL. Older age was associated with worse total PedsQL, pain, nausea, worry, and posture (all ps < .05). Greater worry (β = 0.51) and worse posture (β = 0.41) were the QOL variables most strongly correlated with older age. Poorer posture was associated with worse child PedsQL (total score, nausea, treatment anxiety, cognitive) and parent PedsQL (pain, nausea). Worse scores on the Faces Scale, PedsQL, and posture were all correlated (rs = .21 - .39, all ps < .05). Interventions to improve QOL could target nausea, worry, and older patients. Accuracy and interpretation of symptom distress in children is problematic. The Faces Scale and posture may be suitable, readily obtained measures of QOL in pediatric oncology that hold promise.

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Association of Race and Family Socioeconomic Status With Pediatric Postoperative Mortality

et al. 2022

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IMPORTANCE Racial disparities in postoperative outcomes have remained difficult to eliminate. It is commonly understood that socioeconomic status (SES) is an important factor associated with excess risk of postoperative morbidity and death. To date, comparable data exploring the association of family SES with pediatric postoperative mortality are unavailable, and it is unknown whether the advantage provided by higher income status is equitable across racial groups.OBJECTIVE To assess whether increasing family SES is associated with lower pediatric postoperative mortality and, if so, whether this association is equitable among Black and White children. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used data from 51 freestanding pediatric tertiary care hospitals across the US that reported to the Children's Hospital Association Pediatric Health Information System. The study included 1 378 111 Black and White children younger than 18 years who underwent inpatient surgical procedures between January 1, 2004, and December 31, 2020. EXPOSURESThe exposures of interest were race (Black and White) and parental income quartile (used as a proxy for SES and measured by median income quartile of the zip code of residence). Race was self-reported by parents or guardians at admission or assessed by the registration team consistent with each hospital's policy and state legislation. MAIN OUTCOMES AND MEASURESThe primary outcome was risk-adjusted in-hospital mortality rates by race and parental income quartile controlled for baseline covariates. To evaluate whether belonging to the highest income quartile modified the association between race and postoperative mortality, multiplicative and additive interactions were examined. RESULTSAmong 1 378 111 children (773 364 [56.1%] male; mean [SD] age, 7 [6] years) who received inpatient surgical procedures during the study period, 248 464 children (18.0%) were Black, and 1 129 647 children (82.0%) were White; 211 127 children (15.3%) were Hispanic, and 825 477 (59.9%) were non-Hispanic. Only 49 541 Black children (20.3%) belonged to the highest income quartile compared with 482 758 White children (43.0%). The overall mortality rate was 1.2%, and mortality rates decreased as income quartile increased (1.4% in quartile 1 [lowest income], 1.3% in quartile 2, 1.0% in quartile 3, and 0.9% in quartile 4 [highest income]; P < .001). Among those belonging to the 3 lowest income quartiles, Black children had 33% higher odds of postoperative death compared with White children (adjusted odds ratio, 1.33; 95% CI, 1.27-1.39; P < .001). This racial disparity gap persisted among children belonging to the highest income quartile (adjusted odds ratio, 1.39; 95% CI, 1.25-1.54; P < .001). Postoperative mortality rates among Black children in the highest income quartile (1.30%; 95% CI, 1.19%-1.42%) were comparable to those of White children in the lowest income quartile (1.20%; 95% CI, 1.16%-1.25%). The interaction between Black race and income was not (continued) Key Points Question Is i...

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

Cited by 17 publications

References 38 publications

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

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

Associations between Demographics and Quality of Life in Children in the First Year of Cancer Treatment

Association of Race and Family Socioeconomic Status With Pediatric Postoperative Mortality

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