Racial/ethnic, social characteristics and geographic disparities of childhood cancer late-stage diagnosis in Texas, 2005 to 2014

ABSTRACT This 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 social factors. The enhanced 2-step floating catchment area (E2SFCA) method was used to measure relative spatial access to Children’s Oncology Group (COG) hospitals. This study also examined the effect of spatial access to specialized COG services along with other variables in explaining the variations of late-stage diagnosis of childhood cancer. Multilevel logistic regression was used to analyse how individual- and contextual-level factors affect the occurrence of childhood cancer disparities (i.e. late-stage diagnosis). The study revealed that Hispanic children were more likely to be diagnosed at a late-stage, after adjusting for age, race/ethnicity, socioeconomic status (SES), socio-culture, education, spatial access to COG hospitals, percent African American, and health insurance coverage. The study also identified that the childhood cancer stage at diagnosis is associated with spatial access to COG services as well as levels of urbanization. Moreover, findings indicate that contextual-level factors, such as SES, socio-cultural factors, education level, and percent health insurance coverage partially explained some of the childhood cancer disparities. Results from this study will contribute to developing more effective and targeted childhood cancer intervention programs in socially underprivileged areas, focusing on population with lower socioeconomic status and lower education levels, limited English-speaking households, areas with a higher percentage of Hispanics and African Americans, locations with a low level of spatial access to COG services.