Medical Record-Level Evaluation of Impact of Demographic and Socioeconomic Factors on Pediatric Neuro-Oncology Outcomes at a Large Regional Children’s Hospital

Background Prior studies using population-level databases have identified racial and socioeconomic disparities in pediatric CNS tumor outcomes but lack patient-specific detail. This single-center retrospective study used deep chart review to identify individual-level factors, including insurance status, documented social concerns, treatment details, and diagnostic timing, that may explain these disparities. Methods Using electronic health records of patients at Children’s Hospital Colorado from 1986-2020, we identified 898 patients treated for CNS tumors. The primary outcomes of interest were 5-year survival, timing of diagnosis, and treatment. Multivariable logistic regression and Cox regression were used to identify covariates associated with our outcomes of interest. Results We found that age, race, tumor type, diagnosis year, and social concerns influenced receipt and timing of treatment. Age, race, patient rural vs. urban residence, and tumor type impacted survival outcomes. Patients with 3+ social concerns were less likely to survive after 5 years than children with no social concerns (OR 1.66, P = .045). However, on multivariable analysis, children with 2 social concerns were more likely to survive 5 years than children with no concerns (OR 0.55, P = .042). Conclusions Demographic and socioeconomic factors influence type and timing of care, as well as survival outcomes in pediatric patients with CNS tumors. Minority status, age, social factors, and rural/urban status correlate with differences in care. This emphasizes the importance of considering these factors and addressing disparities to achieve equitable care.