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.