INTRODUCTION
While pediatric cancers represent less than 1% of the cancer burden in
the United States, cancer remains the major cause of non-injury related
mortality among children.1,2,3,4 Brain and central
nervous system (CNS) tumors are the most common type of pediatric cancer
in the US after leukemia and have the highest mortality rates among all
cancers affecting children.5,6,7,8,9,10 While the
incidence and mortality of pediatric brain and CNS tumors remains high,
previous research has identified significant differences across racial
and ethnic groups in both diagnosis and treatment in this
population.6,11,12 Several studies have identified a
significantly higher incidence of brain and CNS tumors in non-Hispanic
white children relative to those in racial/ethnic
minorites.7,8,9,13 While scientific breakthroughs in
cancer treatment have improved cancer survival, leading to a one-third
decrease in overall pediatric cancer mortality from 1990-2016, these
advances have not benefited all racial/ethnic groups
equally.1,14 Specifically, despite the observed
improvement in overall survival for pediatric cancers, disparities are
evident in access to and use of guideline-recommended treatment and
outcomes across racial/ethnic groups. 6,15,16,17 Prior
research has demonstrated that minority populations including African
Americans, American Indian, Native populations, and Hispanics have worse
pediatric cancer survival compared to non-Hispanic
whites.7,17,18,19,20,21, These studies have identified
significant opportunities to reduce racial/ethnic disparities to improve
both detection and survival in pediatric cancer patients.
Prior research also demonstrates significant gaps in our understanding
of racial/ethnic disparities in pediatric brain and CNS tumors. Two
previous studies have shown that socioeconomic status (SES) does not
influence the relationship between race/ethnicity and survival for solid
tumors including pediatric brain and CNS tumors,6,22but limited work has been done to evaluate the mechanisms by which
race/ethnicity influences survival outcomes independent of SES. Based on
the existing knowledge gap, the purpose of this study is to explore if
racial/ethnic disparities in survival for pediatric brain and CNS tumors
can be partially explained by sociodemographic and treatment differences
across these populations.