Minority children experience a higher risk of death from many central nervous system tumor types even after accounting for treatment received: A National Cancer Database analysis

• Published in: Cancer 2022-04, Vol.128 (8), p.1605-1615
• Main Authors: Moore, Kristin J., Moertel, Christopher L., Williams, Lindsay A.
• Format: Article
• Language: English
• Subjects: Brain; Brain cancer; Brain tumors; Cancer; Central nervous system; Children; Choroid plexus; Confidence intervals; Death; Ethnicity; Fatalities; Glioblastoma; Hazard identification; Health hazards; Hispanic Americans; mediation analysis; Medulloblastoma; Minority & ethnic groups; Mortality; Oligodendroglioma; Oncology; Pacific Islander people; pediatric brain tumors; Pediatrics; Race; racial disparities; Risk; Statistical analysis; Statistical models; Survival; treatment differences; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34121

Background Brain tumors are the leading cause of death from disease in children. Racial/ethnic minority children have poorer outcomes than White children; however, it is not clear whether this association is mediated by treatment received. Methods Children (aged 0‐19 years) diagnosed with brain tumors in the National Cancer Database (2004‐2016) were identified. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) between race/ethnicity (Black, Hispanic, Asian/Pacific Islander, American Indian/Alaska Native, or White [reference]) and death. An inverse odds weighted mediation analysis was performed with treatment received as the mediator. Results Among 22,469 cases, White children (69% of the sample) had significantly better overall 12.5‐year survival (P < .01). Black children (13% of the sample) and Hispanic children (14% of the sample) had an increased risk of death overall and for glioblastoma and oligodendroglioma. Compared with Whites, Asian/Pacific Islander children had a higher risk of death from choroid plexus tumors and a lower risk of death from medulloblastoma. There were no statistically significant meditating effects by treatment received, although the estimate was borderline in Hispanic children (indirect HR, 1.08; 95% CI, 0.99‐1.18). A treatment‐independent association between race/ethnicity and death remained for Hispanic children (direct HR, 1.18; 95% CI, 1.04‐1.33) and Black children (direct HR, 1.28; 95% CI, 1.13‐1.45). If deaths in minorities had equaled those in White children, 5% fewer total deaths and 15% fewer minority deaths would have occurred. Conclusions Survival disparities exist in pediatric brain tumors and are largely independent of treatment received, but other mechanisms linked to race/ethnicity remain important. Survival disparities exist in pediatric brain tumors and are largely independent of treatment received; this suggests that other mechanisms linked to race/ethnicity remain important. If minority deaths had equaled White deaths in this study, 5% fewer total deaths and 15% fewer minority deaths would have occurred.