Photo by Bill Branson
Child with cancer
Socioeconomic status (SES) may explain some racial/ethnic disparities in childhood cancer survival, according to new research.
The study showed that whites had a significant survival advantage over blacks and Hispanics for several childhood cancers.
SES significantly mediated the association between race/ethnicity and survival for acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), neuroblastoma, and non-Hodgkin lymphoma (NHL).
Rebecca Kehm, PhD, of Columbia University in New York, New York, and her colleagues reported these findings in Cancer alongside a related editorial.
The researchers examined population-based cancer survival data from the Surveillance, Epidemiology, and End Results database.
The team collected information on 31,866 patients, ages 0 to 19, who were diagnosed with cancer between 2000 and 2011.
Survival differences by race/ethnicity
The researchers found that whites had a significant survival advantage over blacks for the cancers listed in the following table.
| Survival—black vs white | |||
| Cancer | Mortality hazard ratio | 95% confidence interval | P value |
| ALL | 1.43 | 1.15-1.77 | <0.01 |
| AML | 1.68 | 1.36-2.07 | <0.001 |
| Neuroblastoma | 1.38 | 1.08-1.75 | 0.01 |
| NHL | 1.53 | 1.14-2.07 | 0.01 |
| Hodgkin lymphoma | 1.66 | 1.06-2.60 | 0.03 |
| Astrocytoma | 1.95 | 1.57-2.43 | <0.001 |
| Non-astrocytoma CNS tumor | 1.53 | 1.25-1.88 | <0.001 |
| Non-rhabdomyosarcoma STS | 1.40 | 1.06-1.84 | 0.02 |
| Rhabdomyosarcoma | 1.44 | 1.10-1.88 | 0.01 |
In addition, whites had a significant survival advantage over Hispanics for the following cancers.
| Survival—Hispanic vs white | |||
| Cancer | Mortality hazard ratio | 95% confidence interval | P value |
| ALL | 1.63 | 1.43-1.86 | <0.001 |
| Neuroblastoma | 1.31 | 1.04-1.65 | 0.02 |
| NHL | 1.65 | 1.29-2.12 | <0.001 |
| Astrocytoma | 1.34 | 1.10-1.64 | <0.01 |
| Wilms tumor | 1.60 | 1.04-2.45 | 0.03 |
| Germ cell tumor | 1.63 | 1.19-2.24 | <0.01 |
Impact of SES
SES significantly mediated the association between race/ethnicity and survival for ALL, AML, neuroblastoma, and NHL but not for Hodgkin lymphoma or other cancers.
For black versus white patients, SES reduced the original association between race/ethnicity and survival by:
- 44% for ALL
- 28% for AML
- 49% for neuroblastoma
- 34% for NHL.
For Hispanics versus whites, SES reduced the original association between race/ethnicity and survival by:
- 31% for ALL
- 73% for AML
- 48% for neuroblastoma
- 28% for NHL.
“These findings provide insight for future intervention efforts aimed at closing the survival gap,” Dr Kehm said.
“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.”
This research was supported by a grant from the National Institutes of Health, and the study’s authors made no disclosures.