Survival disparities for childhood cancers exist when defined by race/ethnicity and sex

• Published in: Cancer epidemiology 2022-12, Vol.81, p.102262-102262, Article 102262
• Main Authors: Moore, Kristin J., Barragan, Freddy, Williams, Lindsay A.
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Astrocytoma; Bone cancer; Brain cancer; Cancer; Childhood; Children; Confidence intervals; Cultural differences; Epidemiology; Ethnicity; Ewings sarcoma; Females; Gender differences; Hazard assessment; Hispanic Americans; Leukemia; Lymphatic leukemia; Lymphoma; Males; Medical diagnosis; Medulloblastoma; Minority & ethnic groups; Nervous system diseases; Neuroblastoma; Osteosarcoma; Pediatric cancer; Pediatrics; Race; Racial/ethnic disparities; Sex differences; Socioeconomic factors; Statistical analysis; Survival; Survivorship; Thyroid cancer; Tumors
• ISSN: 1877-7821; 1877-783X
• DOI: 10.1016/j.canep.2022.102262

There are documented racial/ethnic and sex differences in pediatric cancer survival; however, it is unknown whether pediatric cancer survival disparities exist when race/ethnicity and sex are considered jointly. Using SEER data (2000–2017), we estimated survival differences by race/ethnicity within sexes and by sex within race/ethnicity (White, Black, Hispanic, and Asian/Pacific Islander [API]) for 17 cancers in children aged (0–19 years). Kaplan-Meier curves (Log-Rank p-values) were assessed. Cox regression was used to estimate hazards ratios (HRs) and 95 % confidence intervals (95 % CIs) between race/ethnicity/sex and cancer. We included 51,759 cases (53.6 % male, 51.9 % White). There were statistically significant differences in 18-year survival by race/ethnicity-sex for 12/17 cancers. Within sexes, minorities had an increased risk of death compared to Whites for various cancers including acute lymphoblastic leukemia (ALL) (females: HispanicHR: 1.78, 95 % CI: 1.52, 2.10; BlackHR: 1.70, 95 % CI: 1.29, 2.24; APIHR: 1.42, 95 % CI: 1.07–1.89; males ALL: HispanicHR: 1.58, 95 % CI: 1.39,1.79; BlackHR: 1.57, 95 % CI: 1.26,1,95; API-HR: 1.39, 95 % CI: 1.11, 1.75) and astrocytoma (females: HispanicHR: 1.49, 95 % CI: 1.19, 1.85; BlackHR: 1.67, 95 % CI: 1.29, 2.17; API-HR: 1.51, 95 % CI: 1.05, 2.15; males: HispanicHR:1.27, 95 % CI: 1.04, 1.56; BlackHR: 1.69, 95 % CI: 1.32, 2.17; API-HR: 1.92, 95 % CI: 1.43, 2.58). Sex differences in survival within racial/ethnic groups were observed for White (ALL, osteosarcoma), Hispanic (medulloblastoma), and API (Primitive Neuro-Ectodermal Tumor [PNET]) children. There are disparities in survival by both race/ethnicity and sex highlighting the societal and biologic influences these features have on survival in children with cancer. •Joint consideration of race/ethnicity and sex offers more thorough analysis in cancer disparities research.•Survival disparities by sex varied by racial/ethnic group and malignancy.•Identified six cancers with sex-disparities affecting White, API, and Hispanic children.•Identified 12 cancers with racial disparities within sex groups.