Wang Hongying, Yao Bing, Tang Tao, Gong Meixi, Ma Yuansen, Wu Xiaomei, Zhu Bo
Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China.
Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China.
EClinicalMedicine. 2024 Sep 5;76:102816. doi: 10.1016/j.eclinm.2024.102816. eCollection 2024 Oct.
It is generally recognized that there is unequal mortality in childhood central nervous system (CNS) malignancy in the United States (US), but little is known about the trends and contributors of racial/ethnic disparities in death. We assessed the trends of racial/ethnic disparities in all-cause and cause-specific death, and the contributions of tumour, treatment and socioeconomic factors to this disparity.
This registry-based cohort study included children (aged ≤19 years) diagnosed with malignant CNS tumours, using data from the US population-based cancer registry in the Surveillance, Epidemiology, and End Results (SEER) Program. The clinical outcomes were all-cause and cause-specific death for each racial/ethnic group (White, Black, Hispanic, non-Hispanic Asian/Pacific Islander [API], and non-Hispanic American Indian/Alaska Native [AI/AN] children). We quantified absolute disparities using absolute rate difference in 5-year cumulative incidence of death. Cox proportion risk models were used to estimate the relative racial/ethnic disparities, and the contribution of factors to disparities in death.
In this study, data from 14,510 children with malignant CNS tumours (mean [SD] age, 8.5 [5.7]; 7988 [55.1%] male) were analysed. Overall, the cumulative incidence of death from CNS tumours across four racial/ethnic groups decreased from 2001 to 2020. Black patients had the highest risk of death from all causes and CNS tumours between 2001 and 2020, with adjusted hazard ratios (HR) of 1.52 (1.38-1.68) and 1.47 (1.31-1.64), respectively. The absolute disparity in all-cause death between Hispanic and White patients increased slightly (from 8.2 percentage points [ppt] to 9.4 ppt), and the relative disparity in death from CNS tumours increased from 1.33 (1.15-1.55) in 2001-2005 to 1.78 (1.44-2.20) in 2016-2020. The absolute disparities in death from CNS tumours between Black and White patients (from 11.8 ppt to 4.3 ppt) and between API and White patients (from 10.1 ppt to 5.1 ppt) decreased from 2001-2005 to 2011-2015.
Race/ethnicity disparities in death from CNS tumours among childhood malignant CNS tumours had reduced from 2001 to 2020, and quantifying the contribution of factors to this disparity in death could provide a basis for decreasing mortality among racial/ethnic minority patients.
Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program.
人们普遍认为，美国儿童中枢神经系统（CNS）恶性肿瘤的死亡率存在不平等现象，但对于死亡方面种族/民族差异的趋势和影响因素知之甚少。我们评估了全因死亡和特定原因死亡的种族/民族差异趋势，以及肿瘤、治疗和社会经济因素对这种差异的影响。
这项基于登记的队列研究纳入了诊断为恶性CNS肿瘤的儿童（年龄≤19岁），使用了监测、流行病学和最终结果（SEER）计划中美国基于人群的癌症登记数据。临床结局是每个种族/民族群体（白人、黑人、西班牙裔、非西班牙裔亚裔/太平洋岛民[API]和非西班牙裔美国印第安人/阿拉斯加原住民[AI/AN]儿童）的全因死亡和特定原因死亡。我们使用5年累积死亡发病率的绝对率差来量化绝对差异。使用Cox比例风险模型来估计相对种族/民族差异以及因素对死亡差异的影响。
在本研究中，分析了14510例患有恶性CNS肿瘤的儿童的数据（平均[标准差]年龄，8.5[5.7]岁；7988例[55.1%]为男性）。总体而言，2001年至2020年期间，四个种族/民族群体中CNS肿瘤的累积死亡率有所下降。2001年至2020年期间，黑人患者全因死亡和CNS肿瘤死亡风险最高，调整后的风险比（HR）分别为1.52（1.38 - 1.68）和1.47（1.31 - 1.64）。西班牙裔和白人患者在全因死亡方面的绝对差异略有增加（从8.2个百分点[ppt]增至9.4 ppt），CNS肿瘤死亡的相对差异从2001 - 2005年的1.33（1.15 - 1.55）增至2016 - 2020年的1.78（1.44 - 2.20）。2001 - 2005年至2011 - 2015年期间，黑人和白人患者之间（从11.8 ppt降至4.3 ppt）以及API和白人患者之间（从10.1 ppt降至5.1 ppt）CNS肿瘤死亡的绝对差异有所下降。
2001年至2020年期间，儿童恶性CNS肿瘤中CNS肿瘤死亡的种族/民族差异有所减少，量化因素对这种死亡差异的影响可为降低种族/民族少数群体患者的死亡率提供依据。
沈阳市中青年科技创新人才支持计划。
