Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma Enucleation: A Population-Based Study, SEER 18 2000-2014

To determine the effect of race, ethnicity, and census tract–level composite socioeconomic status (SES) on retinoblastoma enucleation. This study augments Truong and associates, providing multivariate analyses combining sociodemographic and clinical characteristics with more accurate SES measures. We hypothesized that children from nonwhite, Hispanic, and lower socioeconomic backgrounds would have increased adjusted odds of enucleation. Retrospective cohort analysis. Multicenter population-based study using the Surveillance, Epidemiology, and End Results (SEER) 18 Registries. Children aged 18 years and younger diagnosed with retinoblastoma between 2000 and 2014. Subjects were identified using International Classification of Diseases–Oncology (ICD-O) site and morphology codes. Enucleation odds ratios (ORs) and 95% confidence intervals (CIs). Analysis of 959 retinoblastoma patients revealed that 70.8% were enucleated. Adjusted analyses showed associations between enucleation and Asian (OR 2.00, CI 1.08–3.71) or black (2.42, 1.41–4.16) race, Hispanic ethnicity (1.69, 1.16–2.46), and low SES (1.68, 1.09–2.58). Significantly increased enucleation risk was associated with older age at diagnosis (age 1-2 years 2.55, 1.80–3.61; >2 years 4.88, 2.57–9.25), unilateral disease (5.00, 3.45–7.14), and advanced stage (regional 4.71, 2.51–8.84; distant 3.15, 1.63–6.08). No interactions were observed between race, ethnicity, SES, and stage at diagnosis. Enucleation rates decreased over time across all racial, ethnic, and socioeconomic groups. Children from nonwhite, Hispanic, and lower socioeconomic backgrounds are more likely to receive enucleation. These associations are independent of stage of diagnosis, suggesting larger systemic disparities in retinoblastoma care. The origin of these differences requires further study and attention by clinicians and policy makers. •Almost three-fourths of retinoblastoma patients in this study were enucleated.•Nonwhite and Hispanic children are more likely to be enucleated.•Children of lower socioeconomic status are more likely to be enucleated.•Disparities in enucleation rates appear unrelated to delayed diagnosis.•Disparities in enucleation continue to persist despite changing treatment patterns.