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Association of Neighborhood Opportunity With Severity of Retinoblastoma at Presentation
Francisco Altamirano-Lamarque1, Caleb Lim2, Ankoor S Shah1
1From the Department of Ophthalmology (F.A.L., A.S.S., D.K.V., E.G., I.O.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Children in low opportunity neighborhoods, especially those with low education, are more likely to be diagnosed with advanced retinoblastoma. Improving access to eye care in underserved areas is crucial to address these disparities.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Social Determinants of Health
Background:
- Retinoblastoma, a pediatric eye cancer, often presents at advanced stages in children from disadvantaged backgrounds.
- Socioeconomic factors, such as neighborhood opportunity, may influence disease presentation and severity.
Purpose of the Study:
- To investigate the association between the Child Opportunity Index (COI) and the severity of retinoblastoma at diagnosis.
Main Methods:
- A cross-sectional study analyzed 125 children under 18 with retinoblastoma.
- The Child Opportunity Index (COI) was determined by residential census tract.
- Mixed effects regression models assessed the link between COI scores and International Classification of Retinoblastoma (ICRB) Groups D or E.
Main Results:
- 87.2% of children presented with advanced retinoblastoma (ICRB Group D or E).
- Children in low overall COI neighborhoods had increased odds of advanced retinoblastoma (OR, 1.62).
- Low education COI scores were significantly associated with higher odds of advanced retinoblastoma (OR, 1.77; P = .013).
Conclusions:
- Children in low opportunity neighborhoods, particularly those with low educational opportunity, are more likely to present with advanced retinoblastoma.
- Targeted interventions to enhance preventative vision care and specialty eye care access in low-resource areas are essential to mitigate retinoblastoma disparities.
Purpose:
To examine the relationship between the Child Opportunity Index (COI) and severity of retinoblastoma at presentation.
Design:
Cross-sectional study.
Methods:
Children (age <18 years) treated for retinoblastoma at a tertiary care center between January 2000 and May 2023 were included. Residential census tract was used to determine the overall and domain-specific COI score for each child. Collected variables included age, sex, race/ethnicity, insurance type, and the International Classification of Retinoblastoma (ICRB) Group at initial examination. The primary outcome was Group D or E retinoblastoma at presentation. Mixed effects regression models were used to estimate the association of COI scores with disease severity at presentation.
Results:
This study included 125 children (51.2% male). Median age at diagnosis was 13 months (IQR, 5-24 months). One hundred nine (87.2%) children presented with Group D or E retinoblastoma and 33 (26.4%) resided in low or very low opportunity neighborhoods. Children residing in neighborhoods with low overall COI scores (OR, 1.62; 95% CI, 1.01-2.58; P = .044) and low education COI scores (OR, 1.77; 95% CI, 1.13-2.79; P = .013) were at increased odds of presenting with ICRB Group D or E retinoblastoma after adjusting for individual-level socioeconomic factors.
Conclusion:
Children residing in low opportunity neighborhoods-particularly low education opportunity-more often presented with advanced stage retinoblastoma than children residing in neighborhoods with higher opportunity scores. Efforts to improve preventative vision care and access to eye specialty care for children residing in low-resource areas are needed to reduce existing disparities in retinoblastoma.
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