London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, 19104, PA, USA.
London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK.
Cancer Epidemiol. 2020 Feb;64:101644. doi: 10.1016/j.canep.2019.101644. Epub 2019 Nov 26.
Central nervous system (CNS) malignancy is the commonest cause of cancer death in children and adolescents (0-19 years) in high-income settings. There is limited data on survival inequalities by race/ethnicity and socioeconomic position (SEP), for young patients, we aim to analyse their influence on survival from childhood CNS tumour.
9577 children and adolescents diagnosed with primary malignant CNS tumours during 2000-2015, followed up until Dec 31 st, 2015, and reported to cancer registries (Surveillance, Epidemiology and End Results programme) were included in the analysis. Cox regression models estimated the hazard ratios for race/ethnicity, SEP, and individual insurance status, adjusting for sex, age, diagnostic period, and tumour type. Individual-level insurance status data were available from 2007.
62.5 % children and adolescents were non-Hispanic White, 10.6 % were non-Hispanic Black and 26.9 % were Hispanic. Race/ethnicity was strongly associated with survival (p < 0.001), even after adjusting for SEP, with Black (HR = 1.39 [95 %CI 1.23-1.58]) and Hispanic children (HR = 1.40 [95 %CI 1.28-1.54]) having higher hazards of death than White children. This association remained after adjusting for insurance status. There was an apparent positive association between SEP and survival that was largely attenuated after adjustment for insurance status (p = 0.20). Survival was comparable between those privately and Medicaid-insured.
Non-Hispanic Black and Hispanic children had lower survival than their White counterparts. This association, not fully explained by differences in SEP, tumour subtype or health insurance, could be related to racially/ethnically-driven barriers to optimal healthcare, warranting further investigation.
在高收入国家，中枢神经系统（CNS）恶性肿瘤是儿童和青少年（0-19 岁）癌症死亡的最常见原因。目前关于种族/民族和社会经济地位（SEP）与年轻患者生存不平等的数据有限，本研究旨在分析其对儿童中枢神经系统肿瘤患者生存的影响。
纳入了 2000 年至 2015 年间被诊断为原发性恶性 CNS 肿瘤且随访至 2015 年 12 月 31 日的 9577 名儿童和青少年患者，这些患者的信息都被报告给了癌症登记处（监测、流行病学和最终结果计划）。采用 Cox 回归模型估计了种族/民族、SEP 和个人保险状况的危险比，同时调整了性别、年龄、诊断时期和肿瘤类型等因素。个人保险状况数据可从 2007 年获得。
62.5%的儿童和青少年是非西班牙裔白人，10.6%是非西班牙裔黑人，26.9%是西班牙裔。种族/民族与生存密切相关（p<0.001），即使在调整了 SEP 后也是如此，黑人（HR=1.39 [95%CI 1.23-1.58]）和西班牙裔儿童（HR=1.40 [95%CI 1.28-1.54]）的死亡风险高于白人儿童。这种关联在调整了保险状况后仍然存在。SEP 与生存之间存在明显的正相关关系，但在调整了保险状况后这种相关性大大减弱（p=0.20）。私人保险和医疗补助保险之间的生存情况相当。
非西班牙裔黑人儿童和西班牙裔儿童的生存率低于其白人同龄人。这种关联不能完全用 SEP、肿瘤亚型或健康保险的差异来解释，可能与种族/民族驱动的优质医疗保健障碍有关，需要进一步调查。
