Individual- and community-level correlates of pediatric central nervous system tumor disparities in the US.

Autor:	Rastatter JC; 1Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.; 2Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois., Chelius DC; 3Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas., Alden TD; 4Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois., DeCuypere M; 4Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois., D'Souza JN; 5Louisiana State University Health Sciences Center, Department of Otolaryngology and Division of Pediatric Otolaryngology, Children's Hospital of New Orleans, Louisiana., Sheyn AM; 6Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, Memphis, Tennessee.; 7Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.; 8Department of Pediatric Otolaryngology, St. Jude Children's Research Hospital, Memphis, Tennessee; and., Fei-Zhang DJ; 9Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Pediatrics [J Neurosurg Pediatr] 2024 Oct 25, pp. 1-13. Date of Electronic Publication: 2024 Oct 25.
DOI:	10.3171/2024.9.PEDS24180
Abstrakt:	Objective: The aim of this study was, through comprehensive, multilevel models of social determinants of health (SDoH) factors, including the Yost Index socioeconomic status (SES) score, to determine whether community- or individual-level SDoH factors quantifiably influence pediatric CNS tumor disparities more in care and prognosis across the US. Methods: The authors performed a retrospective cohort study assessing specialized Surveillance, Epidemiology, and End Results data of pediatric patients (≤ 19 years old) with nonmalignant and malignant tumors of the CNS from 2010 to 2018. A census-level Yost Index SES score and rurality/urbanicity measures were incorporated with individual characteristics of age, sex, and race/ethnicity. Chi-square analyses for clinical and demographic descriptions, multivariate Cox proportional hazards logistic regressions for survival, and multivariate logistic regressions for resection, radiation treatment, treatment delay, and advanced staging on preliminary presentation were performed. Results: Across 18,236 patients, age-adjusted analyses showed substantially increased mortality risk among 6 of 11 subtypes (highest hazard ratio [HR] 1.91, 95% CI 1.59-2.28, p < 0.001 for glioma NOS), decreased odds of first-line therapy among 7 of 18 subtypes (lowest OR 0.36, 95% CI 0.11-0.97, p = 0.043 for resection of choroid plexus papilloma), increased odds of treatment delay among 6 of 11 subtypes (highest OR 2.47, 95% CI 1.01-6.49, p = 0.047 for germinoma), increased odds of advanced staging on preliminary presentation among 3 of 10 malignant subtypes (highest OR 2.56, 95% CI 1.27-5.52, p = 0.008 for malignant ependymomas), and increased odds of receipt of radiation therapy among 3 of 10 malignant subtypes (highest OR 2.30, 95% CI 1.87-2.84, p < 0.001) observed across many disease subtypes contributed by certain individual- and community-level SDoH factors. Conclusions: Through comprehensive analyses combining individual- and community-level SDoH factors, this study identified detrimental interrelated SDoH associations with poorer care and prognosis of pediatric patients with CNS tumors, delineating how both levels differentially contribute to observed disparities across different subtypes.
Databáze:	MEDLINE
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