Racial and Ethnic Disparities in Survival of Children with Brain and
Central Nervous Tumors in the United States
Abstract
BACKGROUND Despite improvements in overall survival for pediatric
cancers, treatment disparities remain for racial/ethnic minorities
compared to non-Hispanic white; however, the impact of race on treatment
outcomes for pediatric brain and central nervous system (CNS) tumors in
the United States is not well known. METHODS We included 8713 children
aged 0 – 19 years with newly diagnosed primary brain and CNS tumors
between 2000 – 2015 from the Census Tract-level SES and Rurality
Database developed by Surveillance, Epidemiology and End Results
Program. We used Chi-square tests to assess differences in
sociodemographic, cancer, and treatment characteristics by
race/ethnicity and Kaplan–Meier curves and Cox proportional hazards
models to examine differences in 10-year survival, adjusting for these
characteristics. RESULTS Among 8,713 patients, 56.75% were non-Hispanic
white, 9.59% non-Hispanic black, 25.46% Hispanic, and 8.19% from
“other” racial/ethnic groups. Median unadjusted survival for all
pediatric brain tumors was 53 months but varied significantly by
race/ethnicity with a median survival of 62 months for Non-Hispanic
whites, 41 months for Non-Hispanic blacks, and 40 months for Hispanic
and Other. Multivariable analyses demonstrated minority racial groups
still had significantly higher hazard of death than non-Hispanic whites;
Hispanic [aHR 1.25 (1.18 - 1.31)]; non-Hispanic black [aHR
1.12(1.04 - 1.21)]; Other [aHR 1.22(1.12 - 1.32)]. Results were
consistent when stratified by tumor histology. CONCLUSION We identified
disparities in survival among racial/ethnic minorities with pediatric
brain and CNS tumors, with Hispanic patients having the highest risk of
mortality. Eliminating these disparities requires commitment towards
promoting heath equity and personalized cancer treatment.