P3.F111: Regional-Level Evaluation of Disparities and Trends in Pediatric Cancer

Background: Cancer is a leading cause of morbidity and mortality in the pediatric population, and national-level data suggest that disparities exist; however, regional trends are lacking. The purpose of our study was to evaluate disparities and trends specific to the pediatric population in Texas.

Methods: The Texas Cancer Registry was queried for pediatric patients (ages < 18y) diagnosed with 5 of the most common cancer types between 2006-2018: Leukemia/Lymphoma, Brain, Renal, Adrenal, and Retinal. American Community Survey 5-year population estimates were used to calculate age- and sex-standardized incidence and mortality rates per 100,000 people stratified by race, year, and metro data, and data was analyzed for disparities in the demographics of those affected. Standardized incidence ratios (SIR) and standardized mortality ratios (SMR) and their 95% confidence intervals (CI) were calculated to compare between race, year, and metro categories.

Results: Of 12,671 childhood cancer patients included, leukemia/lymphoma was most common (n=6,524, 51.5%), followed by brain cancers (n=4,769, 37.6%), renal cancers (n=649, 5.1%), adrenal cancers (n=408, 3.2%), and retinal cancers (n=321, 2.5%). Children of non-Hispanic (NH) White race/ethnic group were more commonly affected than those from minority (NH Black and Hispanic) race/ethnic groups in all cancer categories (leukemia/lymphoma SIR=0.85 (CI=0.82-0.87, p<.0001), brain SIR=0.65 (CI=0.63-0.68, p<.0001), renal SIR=0.72 (CI=0.65-0.79, p<.0001), adrenal SIR=0.42 (CI=0.36-0.38, p<.0001), and retinal SIR=0.84 (CI=0.73-0.96, p=0.0071)). Cancer-related mortality was lower for children of minority race/ethnic groups for brain cancer (SMR=0.87, CI=0.79-0.94, p=0.0008) and adrenal cancer (SMR=0.61, CI=0.43-0.78, p<.0001), but higher for leukemia/lymphoma (SMR=1.12, CI=1.02-1.22, p=0.0175). There were no significant differences in mortality rate by race/ethnic groups for renal or retinal cancers.
Comparing the first half and second half of the study period, change in average incidence per 100,000 person-years in each category was +2.3% for leukemia/lymphoma, -2.1% for brain, -8.6% for renal, +11.3% for adrenal, and +12.9% for retinal (all nonsignificant). When stratified by area of residence, an increased incidence was identified in the non-metro populations for all categories (leukemia/lymphoma SIR=1.69 (CI=1.57-1.82, p<.0001), brain SIR=1.91 (CI=1.75-2.07, p<.0001), renal SIR=1.41 (CI=1.06-1.77, p=0.02), adrenal SIR=1.60 (CI=1.13-2.07, p=0.013), and retinal SIR=1.51 (CI=1.00-2.03, p=0.05)). Higher cancer-specific mortality for brain and adrenal cancers was identified in children from non-metro populations (brain SMR=1.87, CI=1.48-2.27, p<.0001 and adrenal SMR=2.60, CI=1.24-2.96, p=0.0213), whereas no variation was noted in the other categories.

Conclusion: The incidence of pediatric cancer has remained relatively stable in Texas during the past decade; however, disparities exist. Incidence was lowest in minority races and metro residence locations in all categories, while cancer-specific mortality was higher for some cancer types based on race/ethnic group and residence location. Further investigation is necessary to elucidate the reasons for these disparities. These findings identify important targets for preventive, screening, and surveillance efforts, and demonstrate the value of regional-level data.