Primary brain tumors comprise approximately 1 % of newly diagnosed cancers in the United States (US), and they exhibit an overall five-year survival rate of 33.4 % [1], [2]. In the US, more than 2000 children receive a diagnosis of brain tumors each year, making it one of the most prevalent forms of cancer among the pediatric population [3]. The State of New Jersey (NJ) has one of the highest rates of pediatric brain tumors (PBTs) in the US [4]. Despite the severity of this issue, little is known regarding the etiology of brain tumors, particularly in relation to environmental factors that may contribute to their development.

While ionizing radiation is a well explored environmental risk factor for brain tumors, recent literature suggests a more complex relationship with other environmental pollutants [5], [6], [7]. For instance, researchers have identified links between brain tumor incidence and exposure to air pollutants like Ozone (O3) and Particulate Matter 2.5 (PM2.5) absorbance [8]. A nationwide study involving over 20,000 cases of brain tumors found associations of PM2.5, nitrous oxides (NOx), and black carbon (BC) with malignant non-glioma brain tumors [9]. Contrarily, pollutants such as sulfur dioxide (SO2), Carbon Monoxide (CO), and nitrogen dioxide (NO2) showed either no correlation or an inverse relationship with brain tumor mortality [10]. Further, while O3 exposure has been shown to increase meningioma risk in men, air pollution overall did not correlate with increased brain cancer risk in women [11]. While valuable, these studies have mixed results and only focus on the adult population. The current literature lacks research on environmental pollutants and their effect on developing brain tumors in the pediatric population. Children, who have a lower age and often limited regional mobility, may experience a more consistent profile of environmental contaminants and thus offer a more controlled environment for studying the effects of environmental contaminants on brain tumor incidence.

Therefore, the present study aims to evaluate the incidence of PBTs in relation to environmental pollutants across all counties in NJ. NJ was chosen as the site of interest due to its position as one of the most densely populated metropolitan states in the US, as well as its position as a state with one of the highest incidences of pediatric brain tumors observed across the US [4]. The secondary objective is to evaluate the relationship of NJ’s social determinants of health and its impact on the pediatric population.