Ethnic and Socioeconomic Factors Associated with Locally Advanced Retinoblastoma: A Retrospective Study

Background Retinoblastoma provides an important opportunity to assess how racial and socioeconomic disparities in health care access may affect the timely diagnosis and treatment of a life-threatening disease. Methods Patients with retinoblastoma treated at a single institution (1999–2021) were retrospectively reviewed with respect to race, ZIP (Zone Improvement Plan) code, and International Intraocular Retinoblastoma Classification (IIRC) Grouping. Socioeconomic disadvantage score (SDS) was assigned based on census data from each ZIP code. Univariate logistic regression was performed, and odds ratio (OR) and 95% confidence intervals (CI) were calculated using the generalized estimating equations (GEE) logistic regression model (SAS, version 9.4) to analyze the probability of locally advanced retinoblastoma with respect to race and SDS. Advanced retinoblastoma was defined as IIRC Group E disease in at least one eye. Results Of 445 patients, 189 presented with Group E disease in at least one eye. Locally advanced retinoblastoma positively correlated with non-White race (OR=1.38, 95% CI (1.03–1.85)). The SDS demonstrated a positive trend with advanced disease but did not reach statistical significance (OR=3.03, 95% CI (0.25–36.27)). Conclusions A significant association was found between non-White race and Group E disease at diagnosis. The correlation between socioeconomic status and advanced disease was positive but not significant, emphasizing the importance of facilitating earlier diagnosis as well as continuing education and outreach efforts to ensure care is delivered as equitably as possible.