Demographic and social determinants of the interval from symptom onset to diagnosis of pediatric brain tumors: a study of the Connecticut Tumor Registry.

Abstract

Objective: Pediatric patients frequently experience long intervals between the initial onset of symptoms and the diagnosis of a brain tumor. Understanding the determinants of the prediagnostic symptomatic interval (PSI) has the potential to facilitate earlier initiation of treatment. Here, the authors studied the impact of demographic factors and social determinants of health on the PSI among pediatric brain tumor patients.

Methods: All pediatric patients with brain tumors included in the Connecticut Department of Public Health's Tumor Registry from 2004 to 2018 were reviewed. Demographic, clinical, and outcomes data were collected. The primary outcome was the log transformation of the PSI (ln(PSI)), which was modeled as a continuous variable. Statistical analyses included multiple linear regression models with stepwise variable selection. The Akaike Information Criterion (AIC) was used to indicate model fit, and bootstrapping was performed to validate the findings.

Results: Overall, 153 patients met the inclusion criteria with a median (IQR) PSI of 30 (14-60) days. Of the tumors, 91 (59.5%) were classified as malignant and 62 (40.5%) as benign. The multivariable linear regression analysis of ln(PSI) demonstrated that longer PSI was positively associated with older age (β = 0.06, p = 0.004) and was negatively associated with Black or African American race (β = -0.64, p = 0.023), the presence of hydrocephalus on presentation (β = -0.79, p = 0.011), fatigue (β = -0.61, p = 0.047) or hemiparesis (β = -0.82, p = 0.041) as presenting symptoms, and malignant tumor behavior (β = -0.45, p = 0.042). The multiple linear regression model was statistically significant overall (F(7,145) = 5.42, p < 0.001), explaining approximately 21% of the variance ln(PSI), and bootstrapping with 1000 resamples confirmed the reliability of the regression analysis.

Conclusions: Demographic factors, patterns of presentation, and tumor biology play a role in the interval between symptom onset and the diagnosis of pediatric brain tumors, with potential implications for quality of care and survival. Although this study did not identify a significant association between nondemographic social determinants of health and the PSI, additional studies are needed with more granular measures of economic stability, healthcare access and quality, education access and quality, neighborhood and built environment, and social and community context. Future efforts should target patient populations at increased risk of a prolonged PSI.