Association of Neighborhood Opportunity With Severity of Retinoblastoma at Presentation

Abstract

PurposeTo examine the relationship between the Child Opportunity Index (COI) and severity of retinoblastoma at presentation. DesignCross-sectional study. MethodsChildren (age <18 years) treated for retinoblastoma at a tertiary care center between January 2000 and May 2023 were included. Residential census tract was used to determine the overall and domain-specific COI score for each child. Collected variables included age, sex, race/ethnicity, insurance type, and the International Classification of Retinoblastoma (ICRB) Group at initial examination. The primary outcome was Group D or E retinoblastoma at presentation. Mixed effects regression models were used to estimate the association of COI scores with disease severity at presentation. ResultsThis study included 125 children (51.2% male). Median age at diagnosis was 13 months (IQR, 5-24 months). 109 (87.2%) of children presented with Group D or E retinoblastoma and 33 (26.4%) resided in low or very low opportunity neighborhoods. Children residing in neighborhoods with low overall COI scores (OR, 1.62; 95% CI, 1.01-2.58; p=0.044) and low education COI scores (OR, 1.77; 95% CI, 1.13-2.79; p=0.013) were at increased odds of presenting with ICRB Group D or E retinoblastoma after adjusting for individual-level socioeconomic factors. ConclusionChildren residing in low opportunity neighborhoods – particularly low education opportunity – more often presented with advanced stage retinoblastoma than children residing in neighborhoods with higher opportunity scores. Efforts to improve preventative vision care and access to eye specialty care for children residing in low-resource areas are needed to reduce existing disparities in retinoblastoma.