BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, with diagnosis preceded by symptoms that may include fever, weight loss, fatigue, bleeding and bruising. Timely diagnosis and treatment of ALL may lead to improved outcomes and reduced morbidity from associated complications including tumor lysis syndrome, hyperviscosity, and stroke. PROCEDURE: We performed a retrospective cohort analysis of 274 pediatric pre-B cell ALL and lymphoma patients within Montefiore Health System to determine whether there were factors associated with time from symptom onset to diagnosis. RESULTS: Median time to diagnosis for all patients was 11.5 days (IQR7.8, 14.3) and was similar between Hispanic, Non-Hispanic Black, and Non-Hispanic White racial/ethnic groups (10.5 vs 14.0 vs 8.0 days; p=0.70), and by male and female patients (14 vs 10 days; p=0.08). Those with Medicaid insurance (n=189) were diagnosed sooner than those with private or self-pay insurance (n=85) (median of 10 vs 16 days; p=0.05). Similar findings were demonstrated when evaluating by Medicaid, Private, and Self-Pay insurance types. English and Other language speakers experienced fewer median days from symptom onset to diagnosis date compared to Spanish speakers (11 vs 7 vs 14; p=0.05). Exploratory analyses suggest that insurance status may impact the time to diagnosis to a greater degree in Non-Hispanics, while English language and female sex may represent a greater advantage to Hispanics. CONCLUSIONS: This study demonstrates that insurance status and language preference may impact the time to diagnosis of pediatric ALL. There is further need to confirm our findings and to study possible causes driving these disparities.