Cancer
The Mediating Effect of Socioeconomic Status and Persistent Poverty on Pediatric Cancer Mortality in the USA Josiane Kabayundo* Josiane Kabayundo Apu Das Krishtee Napit Emma Hymel Shinobu Watanabe-Galloway
Background: Existing evidence among adults demonstrates that socioeconomic (SE) factors play a critical role in racial/ethnic disparities in cancer mortality. However, research examining the interplay between SE factors and race/ethnicity in pediatric cancer mortality is limited. Objective: Evaluate the mediating effect of socioeconomic status (SES) and persistent poverty in racial/ethnic mortality of childhood cancer. Methods: The 2006-2020 SEER Research plus specialized data with census tract attributes were used. Cases of age 0-19 years were included. Race/ethnicity was categorized as Non-Hispanic White, Non-Hispanic Asian, Non-Hispanic American Indian/ Alaska Native, Non-Hispanic Black, and Hispanic. Cause-specific Cox-proportional hazard models were used to examine the association of race/ethnicity with cancer mortality, adjusting for covariates. The proportional hazard assumptions were tested using Schoenfeld residuals. A mediation analysis was performed using R4.1.3 mediation package. We performed separate analyses for each mediator. The total, direct, and indirect effects were estimated using the hazard ratio scale and percentage mediated and 95% CIs calculated from 100 bootstraps resampling. Results: 96, 665 cases were included. Using White as a reference, the risk of cancer death was higher among Black (aHR:1.53; 95% CI: 1.45-1.62), Hispanic (aHR:1.17; 95% CI: 1.12-1.22) and PI (aHR: 1.24; 95% CI:1.15-1.33). The proportion mediated by SES was 13.5% (11.7% – 15.1%) for Blacks and 29.3% (26.8 % – 29.5%) for Hispanics. The proportion mediated by persistent poverty was 6% (4.7% – 6.8%) for Blacks, 13% (11.3% – 14%) for Hispanics, and 1% (0.75% -1.1%) for Asians. Conclusion: SES and persistent poverty significantly contributed to disparities, with variations across racial/ethnic groups and cancer types. Addressing these intersecting factors requires multi-level interventions targeting systemic inequities and barriers in clinical care and individual level.