title: Racial and Ethnic Disparities in the Pediatric Hodgkin Lymphoma Population.
abstract: BACKGROUND
  Little is known about the association between race/ethnicity and survival in pediatric Hodgkin lymphoma (HL) patients. In a state-wide pediatric cohort diagnosed with HL, we assessed demographic, disease, and treatment characteristics associated with overall survival (OS). We then attempted to validate these findings and assess disease-specific survival (DSS) in a national Surveillance, Epidemiology, and End Results (SEER) cohort.
  
  
  METHODS
  HL patients of 0.1-21 years diagnosed from 1981 to 2010 were evaluated using the Florida Cancer Data System (FCDS). Kaplan-Meier curves estimated OS from 5 to 25 years based on race/ethnicity, treatment, decade of diagnosis, and sex. Multivariate Cox proportional hazard regressions tested independent factors associated with differences in OS. These methods were replicated in the SEER with additional assessment of DSS.
  
  
  RESULTS
  A total of 1,778 patients were identified in the FCDS and 6,027 in the SEER. Median diagnosis age was 17 years in both cohorts. In the FCDS, Blacks had worse OS than Whites and Hispanics at 25 years (33% vs. 49.2% vs. 44.7%, respectively; P = 0.0005), and Black race was associated with inferior OS on multivariate regression (hazard ratio [HR]: 1.81, P = 0.0003). In the SEER, Blacks had inferior OS (Blacks 74.2% vs. Whites 82% vs. Hispanics 82%; P = 0.0005) and DSS (85.7% vs. 90.8% vs. 88.1%, respectively; P = 0.0002) at 25 years. Hispanic males had inferior DSS compared to White males (84.8% vs. 90.6%; P = 0.0478), and Hispanic race was a predictor for inferior DSS on multivariate analysis (HR: 1.238; P < 0.0001).
  
  
  CONCLUSIONS
  Racial/ethnic disparities persist in the pediatric HL population despite modern treatment; underlying causes of these disparities are complex and need further examination.
authors.affiliation: Department of Radiation Oncology, University of Miami, Miami, Florida.
authors.forename: W R
authors.initials: WR
authors.lastname: Grubb
authors.affiliation: Department of Radiation Oncology, University of Miami, Miami, Florida.
authors.forename: H J
authors.initials: HJ
authors.lastname: Neboori
authors.affiliation: Department of Radiation Oncology, University of Miami, Miami, Florida.
authors.forename: A D
authors.initials: AD
authors.lastname: Diaz
authors.affiliation: Department of Epidemiology and Public Health, University of Miami, Miami, Florida.
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.affiliation: Cancer Research, Sylvester Cancer Center, University of Miami, Miami, Florida.
authors.forename: D
authors.initials: D
authors.lastname: Kwon
authors.affiliation: Department of Radiation Oncology, University of Miami, Miami, Florida.
authors.forename: Joseph
authors.initials: J
authors.lastname: Panoff
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D002648:Child; D002675:Child, Preschool; D005260:Female; D005431:Florida / Q000453:epidemiology; D006630:Hispanic or Latino; D006689:Hodgkin Disease / Q000401:mortality*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D018426:SEER Program; D044465:White People; D055815:Young Adult; D001741:Black or African American
keywords: Hodgkin's lymphoma; SEER; epidemiology; long-term survival; lymphoma; pediatric oncology