title: Health disparities and impact on outcomes in children with primary central nervous system solid tumors.
abstract: OBJECTIVE Health disparities in access to care, early detection, and survival exist among adult patients with cancer. However, there have been few reports assessing how health disparities impact pediatric patients with malignancies. The objective in this study was to examine the impact of racial/ethnic and social factors on disease presentation and outcome for children with primary CNS solid tumors. METHODS The authors examined all children (age ≤ 18 years) in whom CNS solid tumors were diagnosed and who were enrolled in the Texas Cancer Registry between 1995 and 2009 (n = 2421). Geocoded information was used to calculate the driving distance between a patient's home and the nearest pediatric cancer treatment center. Socioeconomic status (SES) was determined using the Agency for Healthcare Research and Quality formula and 2007-2011 US Census block group data. Logistic regression was used to determine factors associated with advanced-stage disease. Survival probability and hazard ratios were calculated using life table methods and Cox regression. RESULTS Children with advanced-stage CNS solid tumors were more likely to be < 1 year old, Hispanic, and in the lowest SES quartile (all p < 0.05). The adjusted odds ratios of presenting with advanced-stage disease were higher in children < 1 year old compared with children > 10 years old (OR 1.71, 95% CI 1.06-2.75), and in Hispanic patients compared with non-Hispanic white patients (OR 1.56, 95% CI 1.19-2.04). Distance to treatment and SES did not impact disease stage at presentation in the adjusted analysis. Furthermore, 1- and 5-year survival probability were worst in children 1-10 years old, Hispanic patients, non-Hispanic black patients, and those in the lowest SES quartile (p < 0.05). In the adjusted survival model, only advanced disease and malignant behavior were predictive of mortality. CONCLUSIONS Racial/ethnic disparities are associated with advanced-stage disease presentation for children with CNS solid tumors. Disease stage at presentation and tumor behavior are the most important predictors of survival.
authors.affiliation: Department of Pediatrics, Children's Cancer Hospital at The University of Texas MD Anderson Cancer Center;|Departments of 2 Surgical Oncology.|Department of Pediatric Surgery, University of Texas Medical School at Houston.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
authors.affiliation: Department of Pediatric Surgery, University of Texas Medical School at Houston.
authors.forename: Emma
authors.initials: E
authors.lastname: Hamilton
authors.affiliation: Department of Pediatric Surgery, University of Texas Medical School at Houston.
authors.forename: Denna
authors.initials: D
authors.lastname: Zebda
authors.affiliation: Health Services Research, and.
authors.forename: Hoang
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Eberth
authors.affiliation: Health Services Research, and.
authors.forename: Yuchia
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Health Services Research, and.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.affiliation: Neurosurgery, The University of Texas MD Anderson Cancer Center.|Department of Pediatric Surgery, University of Texas Medical School at Houston.|Department of Neurosurgery, University of Texas Health Science Center at Houston and Mischer Neuroscience Institute, Houston, Texas; and.
authors.forename: David I
authors.initials: DI
authors.lastname: Sandberg
mesh_terms: D000293:Adolescent; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000208:ethnology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program / Q000191:economics / Q000639:trends; D012923:Social Class; D013781:Texas / Q000208:ethnology; D016896:Treatment Outcome
keywords: CDC = Centers for Disease Control and Prevention; DSHS = Department of State Health Services; HR = hazard ratio; ICD-O-3 = International Classification of Diseases for Oncology, 3rd Edition; NPCR = National Program of Cancer Registries; OS = overall survival; SEER = Surveillance, Epidemiology and End Results Program; SES = socioeconomic status; TCR = Texas Cancer Registry; ethnicity; oncology; pediatric CNS tumors; race; socioeconomic status; survival