{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T02:31:30Z","timestamp":1767925890060,"version":"3.49.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Little is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors conducted a retrospective study of pediatric patients (&lt; 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson\u2019s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p &lt; 0.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p &lt; 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>No significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.4.peds18594","type":"journal-article","created":{"date-parts":[[2019,6,21]],"date-time":"2019-06-21T21:53:17Z","timestamp":1561153997000},"page":"159-165","source":"Crossref","is-referenced-by-count":17,"title":["Social determinants of health affecting treatment of pediatric brain tumors"],"prefix":"10.3171","volume":"24","author":[{"given":"Jillian M.","family":"Berkman","sequence":"first","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt;"},{"name":"Department of Internal Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Dallas","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt;"},{"name":"Vanderbilt University School of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaims","family":"Lim","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt;"},{"name":"Department of Neurosurgery, School of Medicine and Biomedical Sciences, University of Buffalo, State University of New York at Buffalo, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritwik","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt;"},{"name":"Vanderbilt University School of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber","family":"Gaulden","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen R.","family":"Gannon","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chevis N.","family":"Shannon","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam J.","family":"Esbenshade","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Hematology-Oncology, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Int J Cancer","doi-asserted-by":"publisher","first-page":"2856","DOI":"10.1002\/ijc.30029","article-title":"Socioeconomic disparities in childhood cancer survival in Switzerland","volume":"138","author":"Adam M","year":"2016","unstructured":"Adam M, Rueegg CS, Schmidlin K, Spoerri A, Niggli F, Grotzer M, : Socioeconomic disparities in childhood cancer survival in Switzerland. Int J Cancer 138:2856\u20132866, 201610.1002\/ijc.3002926840758"},{"key":"b2","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"585","DOI":"10.3171\/2016.5.PEDS15704","article-title":"Health disparities and impact on outcomes in children with primary central nervous system solid tumors","volume":"18","author":"Austin MT","year":"2016","unstructured":"Austin MT, Hamilton E, Zebda D, Nguyen H, Eberth JM, Chang Y, : Health disparities and impact on outcomes in children with primary central nervous system solid tumors. J Neurosurg Pediatr 18:585\u2013593, 20162754095710.3171\/2016.5.PEDS15704"},{"key":"b3","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.jpedsurg.2014.10.037","article-title":"Health disparities are important determinants of outcome for children with solid tumor malignancies","volume":"50","author":"Austin MT","year":"2015","unstructured":"Austin MT, Nguyen H, Eberth JM, Chang Y, Heczey A, Hughes DP, : Health disparities are important determinants of outcome for children with solid tumor malignancies. J Pediatr Surg 50:161\u2013166, 20152559811610.1016\/j.jpedsurg.2014.10.037"},{"key":"b4","series-title":"Cancer Causes Control","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1007\/s10552-004-7843-2","article-title":"Pediatric brain tumors in non-Hispanics, Hispanics, African Americans and Asians: differences in survival after diagnosis","volume":"16","author":"Barnholtz-Sloan JS","year":"2005","unstructured":"Barnholtz-Sloan JS, Severson RK, Stanton B, Hamre M, Sloan AE: Pediatric brain tumors in non-Hispanics, Hispanics, African Americans and Asians: differences in survival after diagnosis. Cancer Causes Control 16:587\u2013592, 200510.1007\/s10552-004-7843-215986114"},{"key":"b5","series-title":"J Natl Cancer Inst","first-page":"649","article-title":"U.S. cancer mortality: nonwhite predominance","volume":"49","author":"Burbank F","year":"1972","unstructured":"Burbank F, Fraumeni JF Jr: U.S. cancer mortality: nonwhite predominance. J Natl Cancer Inst 49:649\u2013659, 19724647488"},{"issue":"25\u201339","key":"b6","series-title":"J Neurooncol","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-009-9840-5","article-title":"Racial, ethnic and socioeconomic disparities in the treatment of brain tumors","volume":"93","author":"Curry WT Jr","year":"2009","unstructured":"Curry WT Jr, Barker FG II: Racial, ethnic and socioeconomic disparities in the treatment of brain tumors. J Neurooncol 93:25\u201339, 20091943088010.1007\/s11060-009-9840-5"},{"key":"b7","series-title":"Declines in Cancer Death Rates Among Children and Adolescents in the United States, 1999\u20132014. NCHS Data Brief 257","author":"Curtin SC","year":"2016","unstructured":"Curtin SC, Mini\u00f1o AM, Anderson RN: Declines in Cancer Death Rates Among Children and Adolescents in the United States, 1999\u20132014. NCHS Data Brief 257. Washington, DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2016"},{"key":"b8","series-title":"Med Ann Dist Columbia","first-page":"293","article-title":"Comparison of the cancer deaths in the black and white U.S.A. population from 1949 to 1967","volume":"41","author":"Fontaine SA","year":"1972","unstructured":"Fontaine SA, Henschke UK, Leffall LD Jr, Mason CH, Reinhold AW, Schneider R, : Comparison of the cancer deaths in the black and white U.S.A. population from 1949 to 1967. Med Ann Dist Columbia 41:293\u2013298, 19724502790"},{"key":"b9","series-title":"The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved","year":"1999","unstructured":"Haynes MA, Smedley BD (eds): The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. Washington, DC: National Academies Press, 1999"},{"key":"b10","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1002\/cncr.23229","article-title":"Geographic access to cancer care in the U.S","volume":"112","author":"Onega T","year":"2008","unstructured":"Onega T, Duell EJ, Shi X, Wang D, Demidenko E, Goodman D: Geographic access to cancer care in the U.S. Cancer 112:909\u2013918, 20081818929510.1002\/cncr.23229"},{"key":"b11","series-title":"Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care","year":"2003","unstructured":"Smedley BD, Stith AY, Nelson AR (eds): Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press, 2003"},{"key":"b12","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"2109","DOI":"10.1007\/s00381-017-3572-1","article-title":"Presentation and symptom interval in children with central nervous system tumors. A single-center experience","volume":"33","author":"Stocco C","year":"2017","unstructured":"Stocco C, Pilotto C, Passone E, Nocerino A, Tosolini R, Pusiol A, : Presentation and symptom interval in children with central nervous system tumors. A single-center experience. Childs Nerv Syst 33:2109\u20132116, 20172880876510.1007\/s00381-017-3572-1"},{"key":"b13","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1159\/000090458","article-title":"Survival analysis of children with primary malignant brain tumors in England and Wales: a population-based study","volume":"42","author":"Tseng JH","year":"2006","unstructured":"Tseng JH, Tseng MY: Survival analysis of children with primary malignant brain tumors in England and Wales: a population-based study. Pediatr Neurosurg 42:67\u201373, 200610.1159\/000090458"},{"key":"b14","series-title":"Median Income in the Past 12 Months (in 2012 Inflation-Adjusted Dollars). 2008-2012 American Community Survey 5-Year Estimates","author":"U.S. Census Bureau","unstructured":"U.S. Census Bureau: Median Income in the Past 12 Months (in 2012 Inflation-Adjusted Dollars). 2008-2012 American Community Survey 5-Year Estimates. Washington, DC: U.S. Census Bureau (https:\/\/factfinder.census.gov\/faces\/tableservices\/jsf\/pages\/productview.xhtml?src=bkmk) [Accessed April 7, 2019]"},{"key":"b15","series-title":"Strategic Plan, Fiscal Years 2010\u20132015","author":"U.S. Department of Health and Human Services","year":"2010","unstructured":"U.S. Department of Health and Human Services: Strategic Plan, Fiscal Years 2010\u20132015. Washington, DC: U.S. Department of Health and Human Services, 2010 (https:\/\/www.hhs.gov\/sites\/default\/files\/secretary\/about\/priorities\/strategicplan2010-2015.pdf) [Accessed April 7, 2019]"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/24\/2\/article-p159.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/24\/2\/article-p159.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/24\/2\/article-p159.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T12:50:51Z","timestamp":1681563051000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/24\/2\/article-p159.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":15,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2019.4.peds18594","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}