Social Determinants of Health-Driven Disparities in Pediatric Retinoblastoma Diagnosis and Outcomes

Background: Retinoblastoma is the most common primary intraocular malignancy in children and is highly curable when diagnosed and treated promptly. Despite advances in treatment, substantial disparities in disease presentation, globe preservation, and survival persist across populations. Social determinants of health (SDOHs) may contribute to these disparities by influencing access to care, diagnostic timeliness, treatment adherence, and the availability of specialized services. This scoping review examined the current literature on the association between SDOHs and diagnosis, treatment, and clinical outcomes in pediatric retinoblastoma. Methods: The databases searched included PubMed, ScienceDirect, Embase, and Scopus, with Google Scholar used as a supplementary source. Peer-reviewed, English-language original studies published from 2000 to 2026 were eligible if they evaluated at least one SDOHs and reported a clinical or care-related outcome among pediatric patients with unilateral or bilateral retinoblastoma. Studies were screened according to predefined inclusion and exclusion criteria. Results: Of 909 records identified across the included databases, 110 duplicates were removed, 799 titles and abstracts were screened, and 86 full-text articles were assessed for eligibility. In total, 32 studies met the inclusion criteria, representing a total of 25,281 pediatric patients across North America, Asia, Europe, South America, and Africa. Socioeconomic status was the most frequently evaluated SDOH (n = 25), followed by geographic factors (n = 19), education (n = 11), ethnicity (n = 10), race (n = 8), and insurance status (n = 6). Lower socioeconomic status, rural residence, limited educational opportunity, inadequate insurance coverage, and racial or ethnic disparities were associated with delayed diagnosis, advanced disease at presentation, increased enucleation, treatment abandonment, recurrence, and mortality. Global disparities were particularly pronounced, with a reported 3-year survival of 99.5% in high-income countries compared with 57.3% in low-income countries. Rural residence was associated with higher cancer-specific mortality (aHR, 6.12; 95% CI, 2.01–18.59), while non-metropolitan residence was associated with higher odds of local recurrence after globe-sparing treatment (aOR, 8.66; 95% CI, 1.96–38.29). Conclusions: The available literature demonstrates that substantial disparities exist in pediatric retinoblastoma outcomes associated with various SDOHs. These associations may reflect interconnected barriers to early recognition, timely diagnosis, access to specialized treatment, and treatment completion. However, differences in study populations, healthcare systems, and clinical characteristics limit definitive conclusions about the mechanisms underlying these conditions. Strategies addressing financial and geographic barriers, healthcare access, early symptom recognition, and culturally responsive support may help reduce disparities and improve survival and globe preservation in children with retinoblastoma. Future efforts should prioritize equitable access to specialized or tertiary retinoblastoma care and strengthen support for families facing socioeconomic, geographic, and cultural barriers. Further research using standardized clinical and individual-level socioeconomic data is needed to better characterize the complex interactions among SDOHs and identify targeted interventions to improve outcomes across diverse patient populations.