Cancer
Neighborhood-Level Vulnerability and Pediatric Cancer Survival in the United States: An Analysis of SEER Data from 2000-2021 Amelia Nichols* Amelia Nichols Nichols Nichols University of Nebraska Medical Center
Background: It is established that geography impacts health and wellbeing; the Social Vulnerability Index (SVI) is a validated, regularly updated tool summarizing county-level vulnerabilities. Cancer is the leading cause of death by disease in children and adolescents; there are variabilities in survival which may be partially explained by neighborhood-level vulnerability. The objective of this study was to explore the differences in pediatric cancer survival among levels of vulnerability.
Methods: A specialized data set from Surveillance Epidemiology, and End Results (SEER) program with county FIPS codes was matched with SVI 2010 data. Selection criteria included children aged ≤ 19 years with first primary malignancy not identified from death certificate or autopsy. Demographics, cancer type, diagnosis year, and rurality were compared by SVI quartile. A Kaplan Meier curve assessed survival by SVI quartile and multivariable cox proportional hazards modelling assessed the hazards of mortality by SVI and other demographic and clinical factors.
Results: There were 85,768 records that met inclusion criteria. Median overall SVI was 0.66 (IQR: 0.47-0.85). Increasing SVI quartile from lowest to highest vulnerability was associated with worsening survival (p <0.0001). Adjusting for covariates, increased hazards of mortality were seen for males, earlier diagnosis year, non-White race, non-hematologic malignancies, rural residence, and increasing SVI quartile. Compared to the lowest SVI quartile, the adjusted hazard of mortality in the highest quartile is 1.19 (95% CI: 1.13-1.25; p <0.0001).
Conclusions: Despite reductions in pediatric cancer mortality, disparities remain. Increasing SVI is associated with worse survival, even after adjusting for covariates. These findings highlight the importance of incorporating neighborhood-level vulnerabilities into future research to understand the underlying factors impacting survival disparities in increasingly vulnerable geographies