Journal article
Health disparities and impact on outcomes in children with primary central nervous system solid tumors
Journal of neurosurgery. Pediatrics, v 18(5), pp 585-593
Nov 2016
PMID: 27540957
Featured in Collection : UN Sustainable Development Goals @ Drexel
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.
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Details
- Title
- Health disparities and impact on outcomes in children with primary central nervous system solid tumors
- Creators
- Mary T Austin - The University of Texas MD Anderson Cancer CenterEmma Hamilton - Department of Pediatric Surgery, University of Texas Medical School at HoustonDenna Zebda - Department of Pediatric Surgery, University of Texas Medical School at HoustonHoang Nguyen - Health Services Research, andJan M Eberth - University of South CarolinaYuchia Chang - Health Services Research, andLinda S Elting - Health Services Research, andDavid I Sandberg - The University of Texas Health Science Center at Houston
- Publication Details
- Journal of neurosurgery. Pediatrics, v 18(5), pp 585-593
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Web of Science ID
- WOS:000386106200010
- Scopus ID
- 2-s2.0-85013082972
- Other Identifier
- 991021855275904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Pediatrics
- Surgery