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Updated: Apr 1, 2026
Reconstruct Human Retinoblastoma In Vitro
Published on: October 11, 2022
Ethnic, Racial, and Socioeconomic Disparities in Retinoblastoma
Bao Truong1, Adam L Green1, Paola Friedrich1
1Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts2Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Insights
Children with retinoblastoma from low socioeconomic backgrounds or Hispanic ethnicity face worse outcomes. These disparities highlight the need for improved access to care for all children with retinoblastoma.
Area of Science:
- Oncology
- Public Health
- Pediatrics
Background:
- Most children in the US are diagnosed with advanced retinoblastoma, requiring intensive treatment or enucleation.
- Disparities in retinoblastoma diagnosis and treatment based on socioeconomic status, race, and ethnicity are not well understood.
Purpose of the Study:
- To investigate the impact of socioeconomic status, race, and ethnicity on retinoblastoma disease extent and patient outcomes.
- To identify specific demographic factors associated with advanced disease and poorer ocular outcomes in children.
Main Methods:
- Population-based review of 830 retinoblastoma cases in children aged 0-9 years from 18 SEER registries (2000-2010).
- Analysis of county-level socioeconomic variables including poverty, education, language isolation, crowding, unemployment, and immigrant population.
- Evaluation of disease extent, ocular outcome, and survival rates.
Main Results:
- Hispanic children had a higher prevalence of extraocular retinoblastoma (33.0% vs. 20.0%).
- Low socioeconomic status indicators (poverty, low education, crowding, unemployment, language isolation, immigrant population) were associated with increased extraocular disease.
- Higher enucleation rates were linked to low educational attainment, crowding, and Hispanic origin.
- Five-year relative survival was lower for Black children (92.7%) compared to non-Hispanic white children (99.2%).
Conclusions:
- Significant disparities in retinoblastoma care and outcomes exist in the US.
- Low socioeconomic status is associated with more advanced disease and poorer ocular outcomes, likely due to limited access to care.
- Hispanic children experience more advanced disease and higher rates of enucleation, underscoring the need for targeted interventions.
Importance:
Most children with retinoblastoma in the United States are diagnosed as having a large intraocular tumor burden that requires intensive ocular-salvage treatment or enucleation.
Objective:
To investigate the effect of socioeconomic status, race, and ethnicity on the extent of disease and the outcomes of retinoblastoma.
Design, Setting, And Participants:
A population-based review of 18 Surveillance, Epidemiology, and End Results (SEER) registries. From January 1, 2000, through December 31, 2010, 830 cases of retinoblastoma were recorded for children aged 0 to 9 years. Data were collected and analyzed from January 1, 2000, through December 31, 2010, with the last follow-up on December 31, 2010.
Exposures:
County-based socioeconomic variables analyzed included poverty level, educational attainment, language isolation, crowding, unemployment, and percentage of immigrants.
Main Outcomes And Measures:
Extent of disease, ocular outcome, and children's survival.
Results:
Of the 830 individuals included, Hispanic children had a higher percentage of extraocular disease (86 of 261 [33.0%] vs. 102 of 510 non-Hispanic children [20.0%]; odds ratio [OR], 1.97 [95% CI, 1.38-2.79]). The percentage of extraocular cases was also higher in counties with the following low socioeconomic status indicators: higher vs. lower poverty status (115 of 413 [27.8%] vs. 73 of 358 [20.4%]; OR, 1.51; 95% CI, 1.06-2.14); lower vs. higher educational attainment (115 of 400 [28.7%] vs. 73 of 371 [19.7%]; OR, 1.65; 95% CI, 1.16-2.34); higher vs. lower levels of crowding (124 of 398 [31.2%] vs. 64 of 373 [17.2%]; OR, 2.18; 95% CI, 1.53-3.13); higher vs. lower unemployment (119 of 411 [28.9%] vs. 69 of 360 [19.2%]; OR, 1.72; 95% CI, 1.21-2.45); higher vs. lower language isolation (117 of 388 [30.2%] vs. 71 of 383 [18.5%]; OR, 1.89; 95% CI, 1.34-2.70); and higher vs. lower percentage of immigrants (109 of 386 [28.2%] vs. 79 of 385 [20.5%]; OR, 1.52; 95% CI, 1.08-2.16). Higher rates of enucleation were associated with low educational attainment (265 of 401 [66.1%] vs 309 of 421 [73.4%]; OR, 1.42; 95% CI, 1.04-1.93), a higher level of crowding (316 of 416 [76.0%] vs. 258 of 406 [63.5%]; OR, 1.81; 95% CI, 1.32-2.48), and Hispanic origin (202 of 271 [74.5%]; OR, 1.41; 95% CI, 1.01-1.98). Relative survival at 5 years was lower among black compared with non-Hispanic white children (92.7% vs. 99.2%; P < .001).
Conclusions And Relevance:
Significant disparities exist in the care and outcomes of children with retinoblastoma. A low socioeconomic status negatively affects disease extent and ocular outcomes, presumably by limiting access to primary and cancer-directed care. Hispanic children in particular have more advanced disease and higher rates of enucleation.
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