Racial disparities in pediatric cancer hospitalizations in the United States

To evaluate racial differences in pediatric cancer-related inpatient hospitalizations in the United States and identify factors associated with inpatient mortality and non-routine discharge.

We performed a retrospective analysis of the Kids' Inpatient Database (KID) from 2006 to 2012. Patients ≤ 20 years old with a cancer diagnosis were identified using Clinical Classifications Software codes. Hospitalizations were categorized by race: White, Black, Hispanic, Asian/Pacific Islander, and Native American/Other. Multivariable logistic regression was used to assess predictors of inpatient mortality, including demographic, socioeconomic, and clinical variables.

A total of 242,489 pediatric cancer-related hospitalizations were identified. The most common diagnoses were leukemia (n = 75,807), other/unspecified malignancies (n = 50,076), bone/connective tissue tumors (n = 42,477), and central nervous system tumors (n = 27,958). Compared with White patients, non-White patients were more frequently hospitalized in large metropolitan areas and more likely to have Medicaid insurance (both p < 0.001). Inpatient mortality was higher among non-White patients compared with White patients (1.5% vs 0.9%, p < 0.001). On multivariable analysis, Black race (odds ratio [OR] 1.56, 95% CI 1.51-1.61), Native American/Other race (OR 1.30, 95% CI 1.25-1.35), self-pay insurance (OR 2.50, 95% CI 2.40-2.62) and lower income quartile (0-25th vs 76-100th; OR 1.28, 95% CI 1.23-1.33) were independently associated with increased odds of inpatient mortality (all p < 0.001).

Racial and socioeconomic disparities are associated with significantly increased inpatient mortality among pediatric cancer-related hospitalizations in the United States. These findings underscore the need for targeted strategies to reduce inequities in pediatric cancer care and healthcare access.