Pediatric Cancer By Race, Ethnicity and Region in the United States

Abstract

Background: In a 2018 descriptive study, cancer incidence in children (age 0-19) in diagnosis years 2003 to 2014 was reported as being highest in New Hampshire and in the Northeast region.

Methods: Using the Cancer in North America (CiNA) analytic file, we tested the hypotheses that incidence rates in the Northeast were higher than those in other regions of the United States either overall or by race/ethnicity group, and that rates in New Hampshire were higher than the Northeast region as a whole.

Results: In 2003 to 2014, pediatric cancer incidence was significantly higher in the Northeast than other regions of the United States overall and among non-Hispanic Whites and Blacks, but not among Hispanics and other racial minorities. However, there was no significant variability in incidence in the states within the Northeast overall or by race/ethnicity subgroup. Overall, statistically significantly higher incidence was seen in the Northeast for lymphomas [RR, 1.15; 99% confidence interval (CI), 1.10-1.19], central nervous system neoplasms (RR, 1.12; 99% CI, 1.07-1.16), and neuroblastoma (RR, 1.13; 99% CI, 1.05-1.21).

Conclusions: Pediatric cancer incidence is statistically significantly higher in the Northeast than in the rest of the United States, but within the Northeast, states have comparable incidence. Differences in cancer subtypes by ethnicity merit further investigation.

Impact: Our analyses clarify and extend previous reports by statistically confirming the hypothesis that the Northeast has the highest pediatric cancer rates in the country, by providing similar comparisons stratified by race/ethnicity, and by assessing variability within the Northeast.

Figure 1.

Derivation of Pediatric (0–19 years) Cancer Cases. *Cancer in North America (CiNA). Kansas and diagnosis year 2003 for Mississippi and Tennessee not included.

Figure 2.

Rate Ratios (RR) and 99% confidence intervals (CI) ^Ɨ of age-standardized childhood cancer incidence rates for states and regions compared with Northeast (NE) among all races - overall§ (A); RR and 99% CIs for states and regions compared with NE among Non-Hispanic Black pediatric cancer cases (B); RR and 99% CIs for states and regions compared with NE among Non-Hispanic White pediatric cancer cases (C); RR and 99% CIs for states and regions compared with NE among Hispanic pediatric cases (D); RR and 99% CIs for states and regions compared with NEs among Non-Hispanic American Indian/Alaska Native (E); RR and 99% CIs for states and regions compared with NE among Non-Hispanic Asian/Pacific Islander pediatric cases (F). Abbreviations: RR: rate ratio; LCI: lower confidence interval; UCI: upper confidence interval; US: United States; ME: Northeast. ^†Bonferroni correction method used to allow for multiple comparisons. Confidence intervals are set at 99% to preserve the 95% confidence level overall *Age standardized rate not calculated for counts < 10. Counts < 10 are italicized. ^§Overall case counts include 2,394 (1.4%) unknown race/ethnicity (Non-Hispanic unknown: N = 2,354; unknown all races: N = 40). ** % of US cases defined as (number of US region cases/number of US total cases)% and ME cases as (number of ME state cases/number of ME total cases)%. Note: The scale minimum-maximum for Figures e) Non-Hispanic American Indian/Alaska Native, f) Non-Hispanic Asian/Pacific Islander has been made different to the other graphs to accommodate the point estimates while retaining the same range. Hence the width of the confidence intervals is comparable to the other figures.

Figure 3.

Pediatric cancer types Ɨ, * Rate Ratio (RR) and 99% confidence intervals (CI) β of age-standardized incidence rates for the Northeast (NE) compared with the United States (US) for all races - overall§ (A); RR and 99% CIs for NE pediatric cancer types compared with US among Non-Hispanic Black (B); RR and 99% CIs for NE pediatric cancer types compared with US among Non-Hispanic White (C); RR and 99% CIs for NE pediatric cancer types compared with US among Hispanic (D); RR and 99% CIs for NE pediatric cancer types compared with US among Non-Hispanic American Indian/Alaska Native (E); RR and 99% CIs for NE pediatric cancer types compared with US among Non-Hispanic Asian/Pacific Islander (F). ^†Complete Cancer Types Titles: I Leukemias, myeloproliferative & myelodysplastic diseases; II Lymphomas and reticuloendothelial neoplasms; III CNS and misc intracranial and intraspinal neoplasms; IV Neuroblastoma and other peripheral nervous cell tumors; V Retinoblastoma; VI Renal tumors; VII Hepatic tumors; VIII Malignant bone tumors; IX Soft tissue and other extraosseous sarcomas; X Germ cell & trophoblastic tumors & neoplasms of gonads; XI Other malignant epithelial neoplasms and melanomas; XII Other and unspecified malignant neoplasms; Not classified by ICCC or in situ (Note that in this study, we excluded in situs but have retained the ICCC site recode nomenclature) *Age standardized rate not calculated for counts < 10. Counts < 10 are italicized (Morris, J.K. [2018]). ^βBonferroni correction method used to allow for multiple comparisons. Confidence intervals are set at 99% to preserve the 95% confidence level overall ^§Overall case counts include 2,394 (1.4%) unknown race/ethnicity (Non-Hispanic unknown: N=2,354; unknown all races: N = 40). Abbreviations: LCI: lower confidence interval; UCI: upper confidence interval; US: United States; Note: The scale maximum for Figure f) Non-Hispanic Asian/Pacific Islander has been made different to the other graphs to accommodate the point estimates for XII Unspecified neoplasms.