Inequities in Pediatric Cancer: Unveiling the Impact of Social Determinants of Health on Survival

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BACKGROUND: The implications of sociodemographic factors across a wide range of pediatric cancers remain unclear. This study aims to assess the impact of social determinants of health (SDOH) on the survival rates of children diagnosed with cancer. METHODS: This retrospective cohort study included children <18 years with cancer in the National Cancer Database (2004-2020). Cancers included were central nervous system (CNS) tumors, leukemia, lymphoma, and non-CNS solid tumors. The primary outcome was five-year overall survival (5-OS). Kaplan-Meier curves and multivariable Cox proportional regression were employed. RESULTS: Of 132,076 children (median age 8 years), 14.8% had CNS tumors, 47.4% leukemia/lymphoma, and 37.8% had non-CNS solid tumors. The median follow-up was 67.3 months. 5-OS was lower in Black (78.9% vs. 84.9%, p < 0.001) and Hispanic (82.1% vs. 84.3%, p < 0.001) children, and those publicly insured (82.1%) and noninsured (80.2%) compared with privately insured (85.8%) (p < 0.001). On multivariable analysis, factors associated with increased hazard of death were Black race (aHR 1.28, 95% CI 1.23-1.34), Hispanic ethnicity (aHR 1.08, 95% CI 1.03-1.12), areas with <93% parental high school graduation (aHR 1.20, 95% CI 1.14-1.25), median household income <$63,331 (aHR 1.11, 95% CI 1.06-1.16), nonprivate insurance (aHR 1.16, 95%CI 1.12-1.20), no insurance (aHR 1.36, 95% CI 1.24-1.49), living in rural/urban areas (aHR 1.05, 95% CI 1.01-1.10) and living ≥60 miles from the treating facility (aHR 1.20, 95% CI 1.15-1.24). CONCLUSIONS: SDOH are associated with disparities in pediatric cancer survival rates. Targeted strategies to enhance care for Black and Hispanic children, as well as those with limited access due to insurance and travel distance, are essential for achieving equitable outcomes for all pediatric cancer patients.

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