Childhood Cancer Disparities in Texas
Morshed, Md Niaz
<p>Cancer is a major public health concern and second leading cause of death in the United States. Although cancer in children represents less than 1% of all new cancer diagnoses, it accounts for considerable death and decreases the span of life. Childhood cancer incidence rate has slowly increased by 0.6 % each year since 1975. Fortunately, there has been a significant improvement in childhood cancer survival because of advancement in medical science and successful enrollment in the clinical trial. However, neither all people receive benefit from such progress, nor all people receive equal benefits. Different population groups of cancer patients experience varying degrees of burden based on the cancer control continuum which includes cancer etiology, prevention, detection, diagnosis, treatment, and overall survivorship.</p> <p>The study investigated childhood cancer disparities in the state of Texas based on data from 1995 to 2014 from the perspective of race/ethnicity, geographic location, and other social domains. This dissertation research used population weighted risk difference to measure the geographic variation of racial/ethnic disparities of childhood cancer late-stage diagnosis. Enhanced 2-step floating catchment area (E2SFCA) method was used to calculate the relative spatial access to the Children Oncology Group (COG) hospitals. Geographic variation of childhood cancer stage at diagnosis was measured using spatial scan statistics.</p> <p>Multilevel logistic regression was used to analyze how individual and contextual level factors impact the occurrence of childhood cancer disparity by race/ethnicity, socioeconomic status (SES), socio-cultural factor, education, percent African-Americans, spatial access to COGs and rural-urban commuting area and percent health insurance coverage. In addition, this study used newly developed causal mediation analysis method to examine childhood cancer survival. The study investigated the effect of race/ethnicity on overall survival of childhood cancer patients while mediated through socioeconomic status and spatial accessibility mediators.</p> <p>There were 54% of the cases diagnosed in their late stage from the study cohort. Although there were few African-American cases compared with non-Hispanic white and Hispanics, they showed significant geographic variation in racial/ethnic disparities compared with their non-Hispanic white counterpart. The study revealed that Hispanic children were more likely to be diagnosed at late-stage after adjusting for age, race/ethnicity, SES, socio-culture, education, spatial access to COGs, percentage of African-American and health insurance coverage. The study also identified a significant difference in spatial accessibility to COG hospitals based on rural-urban commuting area. Moreover, the study found that contextual-level factors explained part of the childhood cancer disparities.</p> <p>Considering all cancer site groups, African-American had statistically significant higher hazard of death compared with non-Hispanic whites mediated by socio-economic status and spatial accessibility. Survival analysis indicated that non-Hispanic white had significantly higher survival probabilities compared with African-Americans. However, the study did not find a significant difference in the survival of Hispanics and Non-Hispanic whites.</p> <p>Results from this study will contribute to developing effective childhood cancer intervention programs in the targeted socially underprivileged areas with lower-socioeconomic status, limited English-speaking household, lower education-level, and areas with a higher percentage of African-Americans. Furthermore, the finding of this study will contribute to the geographical resource allocation system which in turn help to facilitate preventive health care service and alleviate the diseases burden in children.</p>
Childhood cancer, Disparity
Morshed, M. N. (2019). <i>Childhood cancer disparities in Texas</i> (Unpublished dissertation). Texas State University, San Marcos, Texas.