title: Health disparities are important determinants of outcome for children with solid tumor malignancies.
abstract: OBJECTIVE
  The purpose of this study was to identify health disparities in children with non-CNS solid tumor malignancies and examine their impact on disease presentation and outcome.
  
  
  METHODS
  We examined the records of all children (age≤18years) diagnosed with a non-CNS solid tumor malignancy and enrolled in the Texas Cancer Registry between 1995 and 2009 (n=4603). The primary outcome measures were disease stage and overall survival (OS). Covariates included gender, age, race/ethnicity, year of diagnosis, socioeconomic status (SES), and driving distance to the nearest pediatric cancer treatment facility. Statistical analyses included life table methods, logistic, and Cox regression. Statistical significance was defined as p<0.05.
  
  
  RESULTS
  Children with advanced-stage disease were more likely to be male, <10years old, and Hispanic or non-Hispanic Blacks (all p<0.05). Distance to treatment and SES did not impact stage of disease at presentation. However, Hispanic and non-Hispanic Blacks and patients in the lowest SES quartile had the worst 1- and 5-year survival (all p<0.05). The adjusted OS differed by age, race, and stage, but not SES or distance to the nearest treatment facility.
  
  
  CONCLUSIONS
  Race/ethnicity plays an important role in survival for children with non-CNS solid tumor malignancies. Future work should better define these differences to establish mechanisms to decrease their impact.
authors.affiliation: Department of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas. Electronic address: MAustin@mdanderson.org.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
authors.affiliation: Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Hoang
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Department of Epidemiology and Biostatistics, The University of South Carolina, Columbia, South Carolina.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Eberth
authors.affiliation: Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Yuchia
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Andras
authors.initials: A
authors.lastname: Heczey
authors.affiliation: Department of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Hughes
authors.affiliation: Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D044469:Racial Groups; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013781:Texas / Q000453:epidemiology
keywords: Health disparities; Pediatric cancer; Solid tumors; Survival