Medical Student Virginia Commonwealth University Richmond, Virginia, United States
Introduction: Socioeconomic factors such as income and community type have shown to correlate with outcomes in neuro-oncologic care. In pediatric populations, however, fewer conclusions have been drawn on the effects of factors such as race, gender, and insurance status on survival due to the relative rarity of such cases. This analysis utilizes the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program database to determine differences in factors influencing survival in both pediatric and adult CNS malignancies.
Methods: From the SEER Research Nov 2020 (1975-2018) dataset, 29865 patients with malignant CNS tumors (identified by ICD-0-3 code) diagnosed between 1990-2018 and directly causing patient demise were selected and data were collected on age at diagnosis, sex, race, median household income (in 2019 USD), community type (rural-urban continuum), and survival (in months). This cohort was separated into pediatric (ages 0-19, n = 1509) and adult (ages 20 and above, n = 28356) subgroups and independent survival analysis was conducted by income, community type, sex, race, and decade of diagnosis. Kaplan-Meier curves were visualized for each comparison.
Results: Log rank analysis of survival in the pediatric cohort showed greater mortality in females (p = 0.0224) and in the most recent decade (p < 0.0001). The same analysis in the adult cohort showed greater mortality in lower income groups, more rural community settings, females, patients categorized as White, and in the most recent decade (p < 0.0001 for all comparisons).
Conclusion : Unlike in the adult population, income, community setting, and race were not associated with significant differences in survival in the pediatric population, prompting further investigation into healthcare delivery differences between pediatric and adult populations. Further study should focus on the cause of these discrepancies to improve equity in neurosurgical care.
