Racial disparities in pediatric cancer care in the United States: An analysis of the Kids' Inpatient Database.
Authors: Sujith Baliga, Dukagjin Blakaj, Vedat Yildiz, Pranav Puri, Joshua David Palmer
Journal: Journal of Clinical Oncology (2021)

10016 Background: The impact of race and socioeconomic status (SES) on cancer mortality has been elucidated in adult patients, but is not well described in pediatric oncology. We hypothesize that racial and socioeconomic disparities exist in pediatric cancer patients, resulting in higher rates of hospitalization and mortality. Methods: We analyzed the Kids’ Inpatient Database (KID) which shows national estimates of inpatient stays for pediatric patients. Inclusion criteria included patients who were ≤20 with a cancer diagnosis identified through the Clinical Classifications Software (CCS). Variables analyzed were discharge status, patient demographics, hospital characteristics, expected payment source, total visit charge, and length of stay. Initial comparisons between cancer and non-cancer related discharges were performed using a chi-square test. To estimate disparities by race, clinical comparisons were performed across five racial groups: White, Black, Hispanic, Asian/Pacific Islander, and Native American/Other. A multivariable logistic regression model was used to examine predictors of hospitalization and mortality. Results: From 2006-2012, there were 9,488,477 non-cancer related pediatric inpatient stays and 242,489 cancer related stays. Patients with cancer related visits were more likely to be white, male (54.9% vs 46.1%, p &lt; 0.0001), older at admission, have private insurance (52.5% vs 41.7%), and were from a higher income quartile (76 th -100 th percentile, 25.2% vs 19.9%, p &lt; 0.001). These patients also had a higher rate of death during admission (1.2% vs 0.5%, p &lt; 0.0001), higher cost of visit charge ($25,097 vs $8,267, p &lt; 0.001), longer length of stay (4 vs 2 days), and were less likely to be discharged (85.5% vs 92.0%, p &lt; 0.0001).The four most frequent cancer diagnoses associated with hospital admission were leukemia (n = 75,807), Other and Unspecified Primary (n = 50,076), bone/connective tissue tumor (n = 42,477), and central nervous system tumor (n = 27,958). Patients who were non-white were more likely to die during their inpatient stay (1.5% Non-white versus 0.9% White, p &lt; 0.001). On multivariate logistic regression, Black (OR: 1.61, 95% CI: 1.57-1.66, p &lt; 0.0001) and Native American (OR: 1.39, 95% CI: 1.34-1.44, p &lt; 0.0001) race, as well as lower income quartile (OR: 1.24, 95% CI: 1.19-1.28, p &lt; 0.001) were associated with increased odds of death during admission. Conclusions: This is the largest observational study to date to identify the impact of race and SES on pediatric cancer hospitalization and mortality in the United States. Non-white race and lower SES was associated with significantly increased odds of death during admission. Given the significant difference in mortality by race, healthcare policy makers and insurance companies should investigate the specific drivers of increased admission and mortality and develop strategies to address inequity in cancer care.