Racial Disparities in Malignant Primary Brain Tumor Survival in Texas From 1995 to 2013

BACKGROUND Differences among the top five races in Texas will be explored to determine if racial, geographic, and healthcare disparities exist in patients undergoing treatment for a primary malignant brain tumor. METHODS Data were obtained from the Texas Cancer Registry from 1995 to 2013. SAS 9.3 (SAS Institute, Inc., Cary, NC) and SEER*Stat 8.3.2 (National Cancer Institute, Bethesda, MD) software were used to analyze death from malignant brain tumors and cause-specific survival. Survival rates were compared using Kaplan-Meier curves and Log-Rank tests. Hazard ratios were estimated using the Cox proportional hazards regression model. RESULTS Median survival was highest among Asians at 92 months (95% CI: 72, 142) and least among Whites at 20 months (95% CI: 19, 21). Patients living in the Upper Gulf Coast region of Texas had the longest survival time at 31 months (95% CI 29-35%), while those patients in the Texas Panhandle had the shortest survival time at 18 months (95% CI 14-23%). Patients with a poverty index of 0-5% had the highest median survival time of 32 months (95% CI 29-35%), as compared to patients with a poverty index of 10-20% who had a median survival of 22 months (95% CI 21-24%). CONCLUSIONS Ethnic minorities and higher socioeconomic class demonstrated survival advantage. White males had the worst survival of those with primary malignant brain tumors. Other significant factors affecting a patient's survival rate included geographic location, poverty index, sex, and age, thus suggesting a potential genetic and environmental influence.