Racial and Ethnic Disparities in Survival of Children with Brain and Central Nervous Tumors in the United States

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.