Materials/Methods: We prospectively enrolled 196 pediatric patients with tumors of the central nervous system. HR-QOL was evaluated using the validated PedsQL core and tumor modules, with possible scores of 0-100 (higher scores represent better HRQOL). Parent proxy reports (PPR) were collected for children aged 2-18, and child self reports (CSR) were collected for children 6 (when able). Assessments were completed twice during treatment (beginning and end) and then yearly. Patients who progressed were taken off study. Based on parents’ addresses, the following CTL socio-economic data was collected: median family income in the child’s census tract, percentage of individuals in the child’s census tract who attended at least some college, and the percentage of whites in the child’s census tract. These data were then dichotomized based on national medians (e.g., whether the median family income in the census tract was greater than or less than US median family income). Linear regression was used to evaluate whether any of the dichotomized census-tract level socioeconomic factors predicted for change in PedsQL tumor or core module scores from baseline to either end of treatment or one-year after treatment. Age, gender, treatment time (up-front or at progression), irradiated volume (focal or cranio-spinal), distance from our hospital, and extent of surgery (GTR, STR, or biopsy alone) were included as potential confounders. Results: Median age was 9 years (range, 1-19). Common histologies included: 54 patients (27.6%) with medulloblastoma, 36 (18.4%) with ependymoma, 32 (16.3%) with craniopharyngioma, 28 (14.3%) with germ cell tumors, and 26 (13.3%) with low-grade gliomas; 154 patients (80%) were treated up-front; the majority had focal radiation (n Z 116, 59.3%); seventy-seven (39.3%) had GTR. On multivariate analysis, patients living in a census tract with a median family income higher than the national median had a greater improvement in the PPR scores on the PedsQL core module at 1 year (relative improvement Z 18.4, p Z 0.006), but there was no association with the CSR. At no other time point did the dichotomized census-tract level variables predict change in PedsQL core or tumor module scores for either PPR or CSR. Conclusions: At 1-year after proton irradiation, higher median income in a child’s census tract predicts for a positive change in parent reported HRQOL. Neither proportion white nor education level significantly correlated with outcomes in the PPR or CSR of HRQOL Author Disclosure: S.M. McBride: None. K.A. Kuhlthau: None. J. Blossom: None. E. Van Der Weerd: None. J. Delahaye: None. S.M. MacDonald: None. N.J. Tarbell: None. T.I. Yock: None.