Survival disparities for childhood cancers exist when defined by race/ethnicity and sex

Kristin J Moore, Freddy Barragan, Lindsay A. Williams

Research output: Contribution to journalArticlepeer-review


Background: There are documented racial/ethnic and sex differences in pediatric cancer survival; however, it is unknown whether pediatric cancer survival disparities exist when race/ethnicity and sex are considered jointly. Methods: Using SEER data (2000–2017), we estimated survival differences by race/ethnicity within sexes and by sex within race/ethnicity (White, Black, Hispanic, and Asian/Pacific Islander [API]) for 17 cancers in children aged (0–19 years). Kaplan-Meier curves (Log-Rank p-values) were assessed. Cox regression was used to estimate hazards ratios (HRs) and 95 % confidence intervals (95 % CIs) between race/ethnicity/sex and cancer. Results: We included 51,759 cases (53.6 % male, 51.9 % White). There were statistically significant differences in 18-year survival by race/ethnicity-sex for 12/17 cancers. Within sexes, minorities had an increased risk of death compared to Whites for various cancers including acute lymphoblastic leukemia (ALL) (females: HispanicHR: 1.78, 95 % CI: 1.52, 2.10; BlackHR: 1.70, 95 % CI: 1.29, 2.24; APIHR: 1.42, 95 % CI: 1.07–1.89; males ALL: HispanicHR: 1.58, 95 % CI: 1.39,1.79; BlackHR: 1.57, 95 % CI: 1.26,1,95; API-HR: 1.39, 95 % CI: 1.11, 1.75) and astrocytoma (females: HispanicHR: 1.49, 95 % CI: 1.19, 1.85; BlackHR: 1.67, 95 % CI: 1.29, 2.17; API-HR: 1.51, 95 % CI: 1.05, 2.15; males: HispanicHR:1.27, 95 % CI: 1.04, 1.56; BlackHR: 1.69, 95 % CI: 1.32, 2.17; API-HR: 1.92, 95 % CI: 1.43, 2.58). Sex differences in survival within racial/ethnic groups were observed for White (ALL, osteosarcoma), Hispanic (medulloblastoma), and API (Primitive Neuro-Ectodermal Tumor [PNET]) children. Conclusions: There are disparities in survival by both race/ethnicity and sex highlighting the societal and biologic influences these features have on survival in children with cancer.

Original languageEnglish (US)
Article number102262
JournalCancer Epidemiology
StatePublished - Dec 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health (United States) under Award Number T32CA163184 (PI: Allen; KJM) and administered by the University of Minnesota Medical School Program in Health Disparities Research and the University of Minnesota School of Public Health . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work is also supported by the Children’s Cancer Research Fund (LAW).

Publisher Copyright:
© 2022 Elsevier Ltd


  • Pediatric cancer
  • Racial/ethnic disparities
  • Sex differences
  • Survivorship

PubMed: MeSH publication types

  • Journal Article


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