The effect of neighborhood deprivation on access to surgical care for pediatric renal tumors.

OBJECTIVES: Early identification of pediatric renal tumors improves outcomes. Neighborhood deprivation, a composite measure of social determinants of health, is associated with poor oncological outcomes. We studied whether neighborhood deprivation influenced metastatic presentation or treatment approach. STUDY DESIGN: Using State Inpatient Databases (SID), we studied children admitted for nephrectomy for a renal tumor in 15 states (2013-2021). Neighborhood deprivation was measured using the Child Opportunity Index 3.0 (COI). Using univariate and multivariate analyses, we examined whether patients presented with metastatic disease and whether they underwent upfront nephrectomy versus nephrectomy after neoadjuvant chemotherapy (delayed nephrectomy). RESULTS: Out of 1,574 children, 14.2% presented with metastases, and 23.3% underwent delayed nephrectomy. Presentation with metastases and delayed nephrectomy were associated with older age and more complex chronic conditions. Neighborhood deprivation was not significantly associated with presentation with metastases or delayed nephrectomy. CONCLUSIONS: Neighborhood deprivation did not significantly impact the presentation or timing of nephrectomy of pediatric renal tumors; biological factors rather than access to care may be the major drivers of variability. However, administrative databases are limited in their ability to fully inform the study of pediatric renal tumors.