ID #944 Unraveling the intersection of social determinants of health in CNS tumor outcomes in children, adolescents, and young adults
Olivia Palmieri, Ryan Corbett, Vicky Tam, Jo Lynne Rokita, Cassie KlineAbstract
Background
Despite therapeutic advances, outcome disparities in pediatric CNS tumors persist, particularly among patients from historically underrepresented racial and ethnic groups and those affected by adverse social determinants of health.
Methods
We performed a retrospective chart review of patients (age 0-39 years) with CNS tumors from the Children’s Hospital of Philadelphia and previously enrolled in a Pediatric Neuro-Oncology Consortium trial. Fisher’s exact tests evaluated associations between Child Opportunity Index (COI) quintiles or group (COI-low [very low/low]; COI-high [moderate/high/very high]) and demographic data (race, ethnicity, primary insurance, primary language). Kaplan-Meier survival analyses assessed diagnoses stratified by COI, and Cox proportional hazards models were utilized for high-grade glioma (HGG) to account for molecular subtype.
Results
Sixty-six patients were included (median age at diagnosis: 7 years; range: 0.42-32), with 71% residing in COI-high tracts. Patients from very low and low tracts were significantly more likely to have public insurance (OR = 19.5, p = 8.7e-04; OR = 9.61, p = 3.8e-03) and patients from very high COI tracts were likely to have private insurance (OR = 6.20, p = 6.7e-03). Black/African American patients were over-represented in the COI-low group (OR = 7.83, p = 5.2e-03), whereas White patients were over-represented in the COI-high group (OR = 5.18, p = 5.1E-03). Among patients with HGG or diffuse midline glioma, the COI-low group exhibited worse progression-free survival (PFS; 1.40 vs. 1.55 years, p = 0.02). This trend was slightly below statistical significance when adjusting for diagnosis (HR = 3.57, p = 0.06). Among patients with recurrent medulloblastoma, the COI-low group also exhibited worse PFS (1.07 vs. 1.47 years, p = 0.001).
Conclusions
In a cohort of pediatric patients with high-risk CNS tumors, Black/African American and patients with public insurance are more likely to be from COI-low tracts. Patients with HGG or recurrent medulloblastoma from COI-low tracts experience shorter survival. Larger, geographically diverse cohorts incorporating molecular risk factors are needed to further evaluate the impact of COI on survival.