Cancer
The Association Between Persistent Poverty and Pediatric Cancer Survival: An Analysis of SEER Data Emma Hymel* Emma Hymel Krishtee Napit Josiane Kabayundo Shinobu Watanabe-Galloway
Objectives: Cancer is the leading cause of death by disease among children under 15 in the US. Pediatric cancer outcomes are impacted by multilevel exposures, however the full extent to which the social determinants of health impact pediatric cancer survival is not well understood. The objective of this study was to examine the association between persistent poverty and pediatric cancer survival in the US.
Methods: In this population-based longitudinal study, we used data from the Surveillance, Epidemiology, and End Results (SEER)-22 registries database. All primary cases of malignant cancer diagnosed among children aged 0-19 at diagnosis from 2006-2020 were included. Cox proportional hazards modes were used to compute crude and adjusted hazard ratios (aHRs) for the association between persistent poverty and survival. Models were adjusted for age, sex, race/ethnicity, cancer type, and rurality.
Results: 97,132 children were included in our study; 12.63% resided in a persistent poverty census tract at the time of diagnosis. The 5-year relative survival rate was lower among children in persistent poverty census tracts (81.25%, 95% CI: 80.48-81.99%) compared to children living in non-persistent poverty census tracts (85.35%, 95% CI: 85.09-85.60%). In the adjusted model, living in a persistent poverty census tract was associated with a higher risk of cancer death (aHR=1.15, 95% CI: 1.10-1.21). Persistent poverty was associated with survival for children with leukemias (aHR=1.20, 95% CI: 1.09-1.31), central nervous system tumors (aHR=1.14, 95% CI: 1.04-1.26), and hepatic tumors (aHR=1.37, 95% CI: 1.01-1.85). There was no significant interaction between persistent poverty and rurality.
Conclusions: Our study observed lower cancer survival rates among children in persistent poverty neighborhoods. Further research is needed to identify multilevel interventions to mitigate disparities in pediatric cancer outcomes and to examine geographic differences in these disparities.