Racial/Ethnic Disparities in Childhood Cancer Survival in the United States.

BACKGROUND Non-white patients with childhood cancer have worse survival than Non-Hispanic (NH) White patients for many childhood cancers in the United States. We examined the contribution of socioeconomic status (SES) and health insurance on racial/ethnic disparities in childhood cancer survival. METHODS We used the National Cancer Database to identify NH White, NH Black, Hispanic, and children of other race/ethnicities (<18 years) diagnosed with cancer between 2004 and 2015. SES was measured by the area-level social deprivation index (SDI) at patient residence and categorized into tertiles. Health insurance coverage at diagnosis was categorized as private, Medicaid, and uninsured. Cox proportional hazard models were used to compare survival by race/ethnicity. We examined the contribution of health insurance and SES by sequentially adjusting for demographic and clinical characteristics (age group, sex, region, metropolitan statistical area, year of diagnosis, and number of conditions other than cancer), health insurance, and SDI. RESULTS Compared with NH Whites, NH Blacks and Hispanics had worse survival for all cancers combined, leukemias and lymphomas, brain tumors, and solid tumors (all P < 0.05). Survival differences were attenuated after adjusting for health insurance and SDI separately; and further attenuated after adjusting for insurance and SDI together. CONCLUSIONS Both SES and health insurance contributed to racial/ethnic disparities in childhood cancer survival. IMPACT Improving health insurance coverage and access to care for children, especially those with low SES, may mitigate racial/ethnic survival disparities.