The Influence of Ethnicity on Survival from Malignant Primary Brain Tumours in England: A Population-Based Cohort Study

SIMPLE SUMMARY: Previous reports using broad ethnic group classifications have suggested that patient outcomes may vary. This study examined survival differences in malignant primary brain tumours of various morphologies between well-recorded and detailed ethnic groups for the whole of England. An ethnic difference in brain tumour survival was found with patients of an Indian background, Any Other White, Other Ethnic Group, and Unknown/Not Stated Ethnicity Groups having better one-year survival than the White British Group, following adjustment for known prognostic factors. By investigating the ethnic variations associated with better brain tumour survival, we may begin to better understand any ethnic inequalities that exist and possibly identify subgroups of patients that could benefit from personalised medicine. ABSTRACT: Background: In recent years, the completeness of ethnicity data in the English cancer registration data has greatly improved. Using these data, this study aims to estimate the influence of ethnicity on survival from primary malignant brain tumours. Methods: Demographic and clinical data on adult patients diagnosed with malignant primary brain tumour from 2012 to 2017 were obtained (n = 24,319). Univariate and multivariate Cox proportional hazards regression analyses were used to estimate hazard ratios (HR) for the survival of the ethnic groups up to one year following diagnosis. Logistic regressions were then used to estimate odds ratios (OR) for different ethnic groups of (1) being diagnosed with pathologically confirmed glioblastoma, (2) being diagnosed through a hospital stay that included an emergency admission, and (3) receiving optimal treatment. Results: After an adjustment for known prognostic factors and factors potentially affecting access to healthcare, patients with an Indian background (HR 0.84, 95% CI 0.72–0.98), Any Other White (HR 0.83, 95% CI 0.76–0.91), Other Ethnic Group (HR 0.70, 95% CI 0.62–0.79), and Unknown/Not Stated Ethnicity (HR 0.81, 95% CI 0.75–0.88) had better one-year survivals than the White British Group. Individuals with Unknown ethnicity are less likely be diagnosed with glioblastoma (OR 0.70, 95% CI 0.58–0.84) and less likely to be diagnosed through a hospital stay that included an emergency admission (OR 0.61, 95% CI 0.53–0.69). Conclusion: The demonstrated ethnic variations associated with better brain tumour survival suggests the need to identify risk or protective factors that may underlie these differences in patient outcomes.