Original Article
Geographic Variations of Racial/Ethnic Disparities in Late-Stage Diagnosis of Childhood Cancer in Texas
Abstract
Objectives: This study aimed to identify small geographic areas where the childhood cancer yearly incidence and late-stage diagnosis rates were disproportionately higher among racial/ethnic minorities (Hispanics and non-Hispanic African Americans) in Texas.Methods: The study examined childhood cancer disparities in Texas from 2005 to 2014, based on geographic location and race/ethnicity. Relative (risk ratio) and absolute (risk difference) measures were used to investigate racial disparities of childhood cancer late-stage diagnosis in small geographic areas (census tracts). The study investigated childhood cancer yearly incidence- and late-stage diagnosis rates for three racial groups combined. The study also analyzed the temporal change of childhood cancer late-stage diagnosis rates based on the data from census tracts where disparities existed for Hispanics and non-Hispanic African Americans compared with a non-Hispanic white reference group.
Results: A total of 54% of the cases in the study cohort were diagnosed in the late stage. Although there were fewer non-Hispanic African Americans cases compared with non-Hispanic white and Hispanic cases, they showed significant geographic variation in racial/ethnic disparities compared with the non-Hispanic white reference group. The study also revealed that 58 census tracts for non-Hispanic African Americans and 47 census tracts for Hispanics (of 5265) had significantly higher late-stage diagnosis rates compared with non-Hispanic whites. The findings also demonstrated consistent increases in incidence and late-stage diagnosis from 2005 to 2014 for all cases combined.
Conclusions: Most of the significant census tracts with a higher late-stage diagnosis rate for Hispanics were located on the outskirts of the Dallas-Fort Worth, Houston, and San Antonio areas. In contrast, geographic disparities of childhood cancer late-stage diagnosis for non-Hispanic African Americans were found inside the large metropolitan areas of Houston and Dallas-Fort Worth. The findings of this study will help prioritize the geographical allocation of resources, which, in turn, will help to facilitate preventive healthcare services and alleviate the disease burden in children.
Posted in: Medical Oncology47
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References
1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7-30.
2. Kaatsch P. Epidemiology of childhood cancer. Cancer Treat Rev 2010;36:277-285.
3. Armenian SH, Landier W, Hudson MM, et al. Children’s Oncology Group’s 2013 Blueprint for Research: survivorship and outcomes. Pediatr Blood Cancer 2013;60:1063-1068.
4. National Institutes of Health, National Cancer Institute Division of Cancer Control & Population Sciences. Cancer control continuum. https://cancercontrol.cancer.gov/od/continuum.html. Published 2019. Accessed January 13, 2020.
5. Pollock BH, DeBaun MR, Camitta BM, et al. Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia: a Pediatric Oncology Group Study. J Clin Oncol 2000;18:813-823.
6. Bhatia S, Sather HN, Heerema NA, et al. Racial and ethnic differences in survival of children with acute lymphoblastic leukemia. Blood 2002;100:1957-1964.
7. Haimi M. Delay in diagnosis of children with cancer: a retrospective study of 315 children. Pediatr Hematol 2004;21:37-48.
8. Rajput A, Faizi SA, Nir I, et al. Pediatric melanoma in New Mexico American Indians, Hispanics, and non-Hispanic whites, 1981-2009. Am J Surg 2014;207:412-416.
9. Zhan FB, Lin Y. Racial/ethnic, socioeconomic, and geographic disparities of cervical cancer advanced-stage diagnosis in Texas. Womens Health Issues 2014;24:519-527.
10. Grubb WR, Neboori HJ, Diaz AD, et al. Racial and ethnic disparities in the pediatric Hodgkin lymphoma population. Pediatr Blood Cancer 2016;2016:428-435.
11. Keppel K, Pamuk E, Lynch J, et al. Methodological issues in measuring health disparities. Vital Health Stat 2005;2:1-16.
12. Dang-Tan T, Franco EL. Diagnosis delays in childhood cancer: a review. Cancer 2007;110:703-713.
13. Dang-Tan T, Trottier H, Mery LS, et al. Delays in diagnosis and treatment among children and adolescents with cancer in Canada. Pediatr Blood Cancer 2008;2008:468-474.
14. Stefan DC, Siemonsma F. Delay and causes of delay in the diagnosis of childhood cancer in Africa. Pediatr Blood Cancer 2011;56:80-85.
15. Ahrensberg JM, Olesen F, Hansen RP, et al. Childhood cancer and factors related to prolonged diagnostic intervals: a Danish population-based study. Br J Cancer 2013;108:1280-1287.
16. Abdelkhalek ER, Sherief LM, Kamal NM, et al. Factors associated with delayed cancer diagnosis in Egyptian children. Clin Med Insights 2014;8:39-44.
17. Halperin EC, Friedman HS. Is there a correlation between duration of presenting symptoms and stage of medulloblastoma at the time of diagnosis? Cancer 1996;78:874-880.
18. Cecen E, Gunes D, Mutafoglu K, et al. The time to diagnosis in childhood lymphomas and other solid tumors. Pediatr Blood Cancer 2011;57:392-397.
19. Okcu MF, Goodman KJ, Carozza SE, et al. Birth weight, ethnicity, and occurrence of cancer in children: a population-based, incident case-control study in the State of Texas, USA. Cancer Causes Control 2002;13:595-602.
20. Ries LAG, Smith MA, Gurney JG, et al. Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995. https://seer.cancer.gov/archive/publications/childhood. Published 1999. Accessed March 7, 2020.
21. Hsieh MH, Meng MV, Walsh TJ, et al. Increasing incidence of neuroblastoma and potentially higher associated mortality of children from nonmetropolitan areas: analysis of the Surveillance, Epidemiology, and End Results database. J Pediatr Hematol Oncol 2009;31:942-946.
22. Kent EE, Sender LS, Largent JA, et al. Leukemia survival in children, adolescents, and young adults: influence of socioeconomic status and other demographic factors. Cancer Causes Control 2009;20:1409-1420.
23. Metzger ML, Castellino SM, Hudson MM, et al. Effect of race on the outcome of pediatric patients with Hodgkin’s lymphoma. J Clin Oncol 2008;26:1282-1288.
24. Kadan-Lottick NS, Ness KK, Bhatia S, et al. Survival variability by race and ethnicity in childhood acute lymphoblastic leukemia. JAMA 2003;290:2008-2014.
25. Wan N, Zhan FB, Zou B, et al. Spatial access to health care services and disparities in colorectal cancer stage at diagnosis in Texas. Prof Geogr 2013;65:527-541.
26. Whitehead M, Marmot M, Allen J, et al. The concepts and principles of equity and health. Int J Health Serv 1992;22:429-445.
27. Warnecke RB, Oh A, Breen N, et al. Approaching health disparities from a population perspective: the National Institutes of Health Centers for Population Health and Health Disparities. Am J Public Health 2008;98:1608-1615.
28. Texas Health and Human Services, Texas Department of State Health Services. Texas Cancer Registry Annual Report 2019. https://www.dshs.state.tx.us/legislative/2019-Reports/TexasCancerRegistryLegislativeReport.pdf. Published July 2019. Accessed March 7, 2020.
29. Goovaerts P, Meliker JR, Jacquez GM. A comparative analysis of aspatial statistics for detecting racial disparities in cancer mortality rates. Int J Health Geogr 2007;6:32.
30. US Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report. Recommendations for the Framework and Format of Healthy People 2020. https://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf. Published October 28, 2008. Accessed January 15, 2020.
31. Lin Y, Zhan FB. Geographic variations of racial/ethnic disparities in cervical cancer mortality in Texas. South Med J 2014;107:281-288.
32. Tatalovich Z, Zhu L, Rolin A, et al. Geographic disparities in late stage breast cancer incidence: results from eight states in the United States. Int J Health Geogr 2015;14:1-11.
33. Tian N, Goovaerts P, Zhan FB, et al. Identifying risk factors for disparities in breast cancer mortality among African-American and Hispanic women. Womens Health Issues 2012;22:e267-e276.
34. Kuo TM, Mobley LR, Anselin L. Geographic disparities in late-stage breast cancer diagnosis in California. Health Place 2011;17:327-334.
35. Araz NC, Guler E. Delays in diagnosis of childhood cancer in southeastern Turkey and the associated factors. Pediatr Hematol Oncol 2015;32:153-163.
36. Fajardo-Gutiérrez A, Sandoval-Mex AM, Mejia-Aranguré JM, et al. Clinical and social factors that affect the time to diagnosis of Mexican children with cancer. Med Pediatr Oncol 2002;39:25-31.
37. Pollock BH, Krischer JP, Vietti TJ. Interval between symptom onset and diagnosis of pediatric solid tumors. J Pediatr 1991;119:725-732.
38. Rodrigues KES, Latorre Mdo R, de Camargo B. < Delayed diagnosis in retinoblastoma]. J Pediatr (Rio J) 2004;80:511-516.
39. Fluchel MN, Kirchhoff AC, Bodson J, et al. Geography and the burden of care in pediatric cancers mark. Pediatr Blood Cancer 2014;2014:1918-1924.
40. Children’s Oncology Group. https://childrensoncologygroup.org/locations. Accessed January 1, 2020.
41. Fotheringham AS, Wong DWS. The modifiable areal unit problem in multivariate statistical analysis. Environ Plan A 1991;23:1025-1044.
