title: Racial/Ethnic Differences in Adverse Outcomes Among Childhood Cancer Survivors: The Childhood Cancer Survivor Study.
abstract: Childhood cancer survivors carry a high burden of treatment-related morbidity; however, race/ethnicity-specific risks of adverse outcomes are not well understood.
  
  
  
  Data from the Childhood Cancer Survivor Study, a cohort of survivors of at least 5 years, were used to compare Hispanic (n = 750, 5.4%) and non-Hispanic black (NHB: n = 694, 5.0%) survivors to non-Hispanic white patients (NHW: n = 12,397, 89.6%) for late mortality, subsequent neoplasms, and chronic health conditions.
  
  
  
  NHBs and Hispanics reported lower socioeconomic status (SES) and higher prevalence of obesity, and NHBs reported higher prevalence of hypertension. NHBs had higher rate of all-cause mortality (relative rate [RR], 1.4; 95% CI, 1.1 to 1.9; P = .008), which was abrogated (RR, 1.0; 95% CI, 0.8 to 1.4; P = .9) after adjusting for SES. Nonmelanoma skin cancer was not observed among irradiated NHBs, and the risk was lower among Hispanic survivors (RR, 0.3; 95% CI, 0.1 to 0.7) compared with NHWs. Both NHBs and Hispanics demonstrated elevated risks for diabetes; these risks persisted after adjusting for SES and obesity (NHBs: RR, 2.8; 95% CI, 1.1 to 6.7; Hispanics: RR, 3.1; 95% CI, 1.5 to 6.4). NHBs were more likely to report cardiac conditions (RR, 1.8; 95% CI, 1.1 to 2.7), but the risk was attenuated after adjusting for cardiovascular risk factors. Therapeutic exposures did not affect racial/ethnic differences in mortality (all cause or cause specific), chronic health conditions, or subsequent neoplasms.
  
  
  
  By and large, NHB and Hispanic childhood cancer survivors experience a comparable burden of morbidity and mortality to their NHW counterparts. The few differences in risk were explained by the racial/ethnic differences in socioeconomic status and/or cardiovascular risk factors.
authors.affiliation: Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Wendy M. Leisenring, Fred Hutchinson Cancer Center, Seattle WA; Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St. Jude Children's Research Hospital, Memphis, TN; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Wendy M. Leisenring, Fred Hutchinson Cancer Center, Seattle WA; Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St. Jude Children's Research Hospital, Memphis, TN; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.affiliation: Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Wendy M. Leisenring, Fred Hutchinson Cancer Center, Seattle WA; Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St. Jude Children's Research Hospital, Memphis, TN; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.affiliation: Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Wendy M. Leisenring, Fred Hutchinson Cancer Center, Seattle WA; Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St. Jude Children's Research Hospital, Memphis, TN; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Wendy M. Leisenring, Fred Hutchinson Cancer Center, Seattle WA; Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St. Jude Children's Research Hospital, Memphis, TN; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Wendy M. Leisenring, Fred Hutchinson Cancer Center, Seattle WA; Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St. Jude Children's Research Hospital, Memphis, TN; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Wendy M. Leisenring, Fred Hutchinson Cancer Center, Seattle WA; Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St. Jude Children's Research Hospital, Memphis, TN; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL. sbhatia@peds.uab.edu.
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000208:ethnology* / Q000401:mortality*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D017741:Survivors / Q000706:statistics & numerical data