{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:10:46Z","timestamp":1793146246362,"version":"4.5.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The aim of this study was, through comprehensive, multilevel models of social determinants of health (SDoH) factors, including the Yost Index socioeconomic status (SES) score, to determine whether community- or individual-level SDoH factors quantifiably influence pediatric CNS tumor disparities more in care and prognosis across the US.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors performed a retrospective cohort study assessing specialized Surveillance, Epidemiology, and End Results data of pediatric patients (\u2264 19 years old) with nonmalignant and malignant tumors of the CNS from 2010 to 2018. A census-level Yost Index SES score and rurality\/urbanicity measures were incorporated with individual characteristics of age, sex, and race\/ethnicity. Chi-square analyses for clinical and demographic descriptions, multivariate Cox proportional hazards logistic regressions for survival, and multivariate logistic regressions for resection, radiation treatment, treatment delay, and advanced staging on preliminary presentation were performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Across 18,236 patients, age-adjusted analyses showed substantially increased mortality risk among 6 of 11 subtypes (highest hazard ratio [HR] 1.91, 95% CI 1.59\u20132.28, p &lt; 0.001 for glioma NOS), decreased odds of first-line therapy among 7 of 18 subtypes (lowest OR 0.36, 95% CI 0.11\u20130.97, p = 0.043 for resection of choroid plexus papilloma), increased odds of treatment delay among 6 of 11 subtypes (highest OR 2.47, 95% CI 1.01\u20136.49, p = 0.047 for germinoma), increased odds of advanced staging on preliminary presentation among 3 of 10 malignant subtypes (highest OR 2.56, 95% CI 1.27\u20135.52, p = 0.008 for malignant ependymomas), and increased odds of receipt of radiation therapy among 3 of 10 malignant subtypes (highest OR 2.30, 95% CI 1.87\u20132.84, p &lt; 0.001) observed across many disease subtypes contributed by certain individual- and community-level SDoH factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Through comprehensive analyses combining individual- and community-level SDoH factors, this study identified detrimental interrelated SDoH associations with poorer care and prognosis of pediatric patients with CNS tumors, delineating how both levels differentially contribute to observed disparities across different subtypes.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.9.peds24180","type":"journal-article","created":{"date-parts":[[2024,10,26]],"date-time":"2024-10-26T02:21:18Z","timestamp":1729909278000},"page":"1-13","source":"Crossref","is-referenced-by-count":4,"title":["Individual- and community-level correlates of pediatric central nervous system tumor disparities in the US"],"prefix":"10.3171","author":[{"given":"Jeffrey C.","family":"Rastatter","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;"},{"name":"Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C.","family":"Chelius","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tord D.","family":"Alden","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"DeCuypere","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill N.","family":"D\u2019Souza","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center, Department of Otolaryngology and Division of Pediatric Otolaryngology, Children\u2019s Hospital of New Orleans, Louisiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.","family":"Sheyn","sequence":"additional","affiliation":[{"name":"Department of Pediatric Otolaryngology, Le Bonheur Children\u2019s Hospital, Memphis, Tennessee;"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee;"},{"name":"Department of Pediatric Otolaryngology, St. Jude Children\u2019s Research Hospital, Memphis, Tennessee; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Fei-Zhang","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Fam Pract Manag","first-page":"3","article-title":"Screening for social determinants of health: an opportunity or unreasonable burden?","volume":"25","author":"Adler KG","year":"2018","unstructured":"Adler KG. 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