Racial/ethnic and socioeconomic survival disparities for children and adolescents with central nervous system tumours in the United States, 2000–2015. (February 2020)

• Record Type: Journal Article
• Authors: Mitchell, Hannah K.; Morris, Melanie; Ellis, Libby; Abrahão, Renata; Bonaventure, Audrey
• Is Part Of: Cancer epidemiology. Volume 64(2020:Feb.)
• Publication Date: 2020-02
• Subjects: ALL acute lymphoblastic leukemia -- CI confidence interval -- CNS central nervous system -- HR hazard ratio -- IQR interquartile range -- PNET primitive neuroectodermal tumour -- SEER Surveillance, Epidemiology and End Results programme -- SEP socioeconomic position -- US United States; Childhood cancer -- Central nervous system tumour -- Race -- Ethnicity -- Socioeconomic -- Survival -- Social determinants -- SEER; Cancer -- Epidemiology -- Periodicals; Cancer -- Prevention -- Periodicals; Cancer -- Diagnosis -- Periodicals; Carcinogenesis -- Periodicals; 616.994005
• DOI: 10.1016/j.canep.2019.101644
• Languages: English
• ISSNs: 1877-7821

Abstract

Highlights: Central nervous system malignancy is the commonest cause of childhood cancer death in a high-income setting. Hispanic and non-Hispanic Black children had significantly lower survival than White children, even after accounting for socioeconomic position. Children living in lower socio-economic areas tended to have lower survival than those in higher socio-economic areas. However, after accounting for race/ethnicity and insurance status, SEP was not significantly associated with death hazard. Individual insurance status was not associated with survival. Abstract: Background and objectives: Central nervous system (CNS) malignancy is the commonest cause of cancer death in children and adolescents (0–19 years) in high-income settings. There is limited data on survival inequalities by race/ethnicity and socioeconomic position (SEP), for young patients, we aim to analyse their influence on survival from childhood CNS tumour. Methods: 9577 children and adolescents diagnosed with primary malignant CNS tumours during 2000–2015, followed up until Dec 31 st, 2015, and reported to cancer registries (Surveillance, Epidemiology and End Results programme) were included in the analysis. Cox regression models estimated the hazard ratios for race/ethnicity, SEP, and individual insurance status, adjusting for sex, age, diagnostic period, and tumour type. Individual-level insurance status data were available from 2007. Results: 62.5 % children and adolescents were non-Hispanic White, 10.6 % were non-Hispanic Black and 26.9 % were Hispanic. Race/ethnicity was strongly associated with survival (p < 0.001), even after adjusting for SEP, with Black (HR = 1.39 [95 %CI 1.23–1.58]) and Hispanic children (HR = 1.40 [95 %CI 1.28–1.54]) having higher hazards of death than White children. This association remained after adjusting for insurance status. There was an apparent positive association between SEP and survival that was largely attenuated after adjustment for insurance status (p = 0.20). Survival was comparable between those privately and Medicaid-insured. Conclusions: Non-Hispanic Black and Hispanic children had lower survival than their White counterparts. This association, not fully explained by differences in SEP, tumour subtype or health insurance, could be related to racially/ethnically-driven barriers to optimal healthcare, warranting further investigation.