title: Racial and ethnic disparities in risk and survival in children with neuroblastoma: a Children's Oncology Group study.
abstract: OBJECTIVE
  Although health disparities are well-described for many cancers, little is known about racial and ethnic disparities in neuroblastoma. To evaluate differences in disease presentation and survival by race and ethnicity, data from the Children's Oncology Group (COG) were analyzed.
  
  
  METHODS
  The racial/ethnic differences in clinical and biologic risk factors, and outcome of patients with neuroblastoma enrolled on COG ANBL00B1 between 2001 and 2009 were investigated.
  
  
  RESULTS
  A total of 3,539 patients (white, 72%; black, 12%; Hispanic, 12%; Asian, 4%; and Native American, < 1%) with neuroblastoma were included. The 5-year event-free survival (EFS) rates were 67% for whites (95% CI, 65% to 69%), 69% for Hispanics (95% CI, 63% to 74%), 62% for Asians (95% CI, 51% to 71%), 56% for blacks (95% CI, 50% to 62%), and 37% for Native American (95% CI, 17% to 58%). Blacks (P < .001) and Native Americans (P = .04) had a higher prevalence of high-risk disease than whites, and significantly worse EFS (P = .01 and P = .002, respectively). Adjustment for risk group abrogated these differences. However, closer examination of the EFS among high-risk patients who remained event free for 2 years or longer, revealed a higher prevalence of late-occurring events among blacks compared with whites (hazard ratio, 1.5; 95% CI, 1.0 to 2.3; P = .04).
  
  
  CONCLUSIONS
  Black and Native American patients with neuroblastoma have a higher prevalence of high-risk disease, accounting for their worse EFS when compared with whites. The higher prevalence of late-occurring events among blacks with high-risk disease suggests that this population may be more resistant to chemotherapy. Studies focused on delineating the genetic basis for the racial disparities observed in this study are planned.
authors.affiliation: Comer Children's Hospital and University of Chicago, Chicago, IL, USA.
authors.forename: Tara O
authors.initials: TO
authors.lastname: Henderson
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Navin
authors.initials: N
authors.lastname: Pinto
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.forename: Patrick
authors.initials: P
authors.lastname: McGrady
authors.forename: Catherine
authors.initials: C
authors.lastname: Crotty
authors.forename: Can-Lan
authors.initials: CL
authors.lastname: Sun
authors.forename: Susan L
authors.initials: SL
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D008297:Male; D009447:Neuroblastoma / Q000453:epidemiology* / Q000208:ethnology* / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology