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

Introduction: 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, Zone Improvement Plan (ZIP) code, and International Intraocular Retinoblastoma Classification (IIRC) Grouping. Socioeconomic disadvantage score (SDS) was assigned based on census data from each ZIP code. Logistic regression was performed, and odds ratio (OR) and 95% confidence intervals (CIs) were calculated using the generalized estimating equations (GEEs) 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]). When accounting for age at presentation, neither race (OR = 1.13, 95% CI [0.74-1.72]) nor SDS (OR = 4.05, 95% CI [0.23-71.96]) were significantly associated with advanced retinoblastoma. Conclusions: A positive association was found between non-White race and Group E retinoblastoma, though this was not statistically significant after accounting for age at diagnosis. This emphasizes the importance of continuing education and outreach efforts to all patient communities to facilitate earlier diagnosis and ensure that care is delivered as equitably as possible.