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Socioeconomic status may explain racial, ethnic disparities in childhood cancers
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Socioeconomic status mediated racial and ethnic survival disparities for several childhood cancers, including acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma and non-Hodgkin lymphoma, according to findings from a mediation analysis published in Cancer.
“These findings provide insight for future intervention efforts aimed at closing the survival gap,” Rebecca D. Kehm, PhD, doctoral student in the division of epidemiology and community health at University of Minnesota School of Public Health, said in a press release. “For cancers in which socioeconomic status is a key factor in explaining racial and ethnic survival disparities, behavioral and supportive interventions that address social and economic barriers to effective care are warranted; however, for cancers in which survival is less influenced by socioeconomic status, more research is needed on underlying differences in tumor biology and drug processing.”
Previous research has indicated Hispanic and non-Hispanic black children have a lower survival rate than white children for lymphomas, leukemias, central nervous system tumors and other cancers.
To investigate whether racial and ethnic disparities in childhood cancer survival are attributed to underlying differences in socioeconomic status, Kehm and colleagues evaluated population-based cancer survival data from the SEER database of 31,866 black, white and Hispanic children aged up to 19 years diagnosed with cancer between 2000 and 2011.
Researchers used the inverse odds weighting method to test for mediation by socioeconomic status.
Socioeconomic status mediated race and ethnicity association with survival for ALL, AML, neuroblastoma and non-Hodgkin lymphoma.
Nine cancers had significant racial disparities in mortality among black children. Black children had a 38% higher risk for mortality of neuroblastoma and 95% increased risk for mortality of astrocytoma compared with white children (P < .05).
Black children had a higher risk for mortality for all cancers except Wilms tumors, osteosarcoma and germ cell tumors.
Among black children, socioeconomic status decreased the original association between race and ethnicity and survival by 44% in ALL (indirect-effect HR = 1.17; 95% CI, 1.07-1.28), 28% in AML (indirect-effect HR = 1.15; 95% CI, 1.03-1.29) and 49% in neuroblastoma (indirect-effect HR = 1.17; 95% CI, 1.03-1.33).
Socioeconomic status acted as a marginally significant mediator between the disparity for non-Hodgkin lymphoma, with a 34% reduction (indirect-effect HR = 1.16; 95% CI, 0.97-1.37) for black children compared with white children.
Hispanic children had a higher risk for mortality for all cancers except Hodgkin lymphoma, non-astrocytoma CNS tumors, rhabdomyosarcoma and osteosarcoma compared with white children.
Among six cancers with significant ethnic disparities in mortality, Hispanic children had a 31% increased risk for mortality of neuroblastoma and 65% increased risk for mortality of non-Hodgkin lymphoma (P < .05) compared with white children.
For Hispanic children, socioeconomic status decreased an original association between race and ethnicity and survival compared with white children by 31% in ALL (indirect-effect HR = 1.16; 95% CI, 1.08-1.26); 73% in AML (indirect-effect HR = 1.13; 95% CI, 1.03-1.25); 48% in neuroblastoma (indirect-effect HR = 1.14; 95% CI, 1.03-1.26); and 28% in non-Hodgkin lymphoma (indirect-effect HR = 1.15; 95% CI, 1.01-1.31).
Overall, socioeconomic status did not significantly mediate racial and ethnic disparities in survival for other types of childhood cancer including CNS tumors, soft tissue sarcomas, Hodgkin lymphoma, Wilms tumor and germ cell tumors.
Researchers noted that socioeconomic status could not fully account for survival disparities.
“We cannot rule out the potential role of other mediation pathways,” researchers wrote.
“For [ALL, AML, neuroblastoma and non-Hodgkin lymphoma] in particular, racial/ethnic survival disparities could theoretically be addressed through initiatives that reduce social and economic barriers to effective care,” they added. “Such efforts may include expanded health insurance coverage, improved patient care coordination, increased health literacy and supplementation of transportation and childcare costs during treatment.” – by Melinda Stevens
Disclosures: The authors report no relevant financial disclosures.
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