Journal of pediatric surgery · 2025
Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma.
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Nofi Colleen P, Roberts Bailey K, Brown Erin G, Rich Barrie S, Kotagal Meera, Glick Richard D
Аннотация
BACKGROUND: The influence of social determinants of health (SDOH) on childhood cancer outcomes is complex and understudied. This study aimed to elucidate the influence of socioeconomic status (SES) and race on survival in Wilms tumor (WT), neuroblastoma (NB), and hepatoblastoma (HB).
METHODS: National Cancer Database was queried from 2004 to 2020 for pediatric patients (aged 0-18) with WT, NB, and HB. A SES composite score was created by combining quartiles for median household income and percent no high school degree (with higher scores reflecting greater disadvantage). Kaplan-Meier analyses and Cox regressions were performed to determine influencers on survival.
RESULTS: This study included 5218 patients with WT, 5851 with NB, and 1311 with HB. The distribution of race for WT, NB, and HB was 59 %, 65 %, and 55 % White non-Hispanic, and 18 %, 11 %, and 11 % Black non-Hispanic patients, respectively. Kaplan-Meier analyses revealed disparate outcomes with higher SES scores having worse survival for WT (p = 0.002) and NB (p = 0.011). In multivariable analysis of children with WT: age, higher SES score, comorbidities, tumor size, and bilateral and metastatic disease were associated with worse survival. For NB: age, urbanicity, higher SES score, Black non-Hispanic race/ethnicity, tumor size, metastatic disease, and chemotherapy were associated with worse survival. For HB: age, comorbidities, and metastatic disease were associated with worse survival.
CONCLUSION: After controlling for patient and tumor characteristics, there are significant associations between SDOH and worse survival for patients with WT and NB. Identification of social risk factors is critical for closing equity gaps and improving outcomes for children with solid tumors.
LEVEL OF EVIDENCE: Level III.
TYPE OF STUDY: Retrospective.
METHODS: National Cancer Database was queried from 2004 to 2020 for pediatric patients (aged 0-18) with WT, NB, and HB. A SES composite score was created by combining quartiles for median household income and percent no high school degree (with higher scores reflecting greater disadvantage). Kaplan-Meier analyses and Cox regressions were performed to determine influencers on survival.
RESULTS: This study included 5218 patients with WT, 5851 with NB, and 1311 with HB. The distribution of race for WT, NB, and HB was 59 %, 65 %, and 55 % White non-Hispanic, and 18 %, 11 %, and 11 % Black non-Hispanic patients, respectively. Kaplan-Meier analyses revealed disparate outcomes with higher SES scores having worse survival for WT (p = 0.002) and NB (p = 0.011). In multivariable analysis of children with WT: age, higher SES score, comorbidities, tumor size, and bilateral and metastatic disease were associated with worse survival. For NB: age, urbanicity, higher SES score, Black non-Hispanic race/ethnicity, tumor size, metastatic disease, and chemotherapy were associated with worse survival. For HB: age, comorbidities, and metastatic disease were associated with worse survival.
CONCLUSION: After controlling for patient and tumor characteristics, there are significant associations between SDOH and worse survival for patients with WT and NB. Identification of social risk factors is critical for closing equity gaps and improving outcomes for children with solid tumors.
LEVEL OF EVIDENCE: Level III.
TYPE OF STUDY: Retrospective.