Socioeconomic Status May Affect Racial/Ethnic Disparities Among Childhood Cancer Survivors

Socioeconomic status may explain racial and ethnic disparities for the survival of several childhood cancers, which, in turn, could justify the allocation of resources to these groups of patients, according to study results published in the journal Cancer.

“Despite improvements over the last four decades in cancer survival in the U.S. pediatric population, marked racial and ethnic disparities persist.,” the study authors wrote. “Compared with non-Hispanic white (white) children, non-Hispanic black (black) and Hispanic children experience lower survival from many cancers, including leukemias, lymphomas, central nervous system tumors and extracranial solid tumors.”

However, previous studies have not formally evaluated interventions by socioeconomic status — defined as, “one's social and economic position in relation to others based on income, education and occupation.”

Therefore, researchers from the University of Minnesota School of Public Health and the Masonic Cancer Center aimed to determine if racial and ethnic disparities in childhood cancer survival could be attributed to underlying differences in socioeconomic status. They used population-based cancer survival data and identified black, white, and Hispanic children who had been diagnosed at the ages of 0 to 19 years in 2000-2011.

Among more than 31,000 childhood cancer survivors who were identified, white patients demonstrated a significant survival advantage over black and Hispanic patients for several cancer types.

In particular, socioeconomic status significantly mediated the association between race/ethnicity and survival for acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), neuroblastoma and non-Hodgkin lymphoma.

For those patients, socioeconomic status reduced the original association between race/ethnicity and survival by 44 percent for black patients compared with white patients with ALL; by 28 percent, respectively, for those with AML; by 49 percent, respectively, for those with neuroblastoma; and by 34 percent, respectively, for those with non-Hodgkin lymphoma.

Similarly, this association was reduced by 31 percent for Hispanic patients compared with white patients with ALL; by 73 percent, respectively, for those with AML; by 48 percent, respectively, for those with neuroblastoma; and by 28 percent, respectively, for those with non-Hodgkin lymphoma.

Of note, socioeconomic status did not significantly contribute to racial and ethnic disparities in survival for other types of childhood cancer including central nervous system tumors, soft tissue sarcomas, Hodgkin lymphoma, Wilms tumor and germ cell tumors.

“This suggests that the association between socioeconomic status and survival is not modified by, and may be shared across, race/ethnicity,” the researchers wrote, adding that the proportion of these disparities did vary by cancer, which may “suggest a differential role of other mediating factors across racial/ethnic groups for some cancers,” they added.

For example, in children with AML, evidence has suggested there is a significantly lower proportion of black patients who match with family donors compared with white and Hispanic patients.

Therefore, the mechanism for which socioeconomic status influences survival is cancer-specific, and initiatives to reduce these disparities should be put in to place. “Such efforts may include expanded health insurance coverage, improved patient care coordination, increased health literacy and supplementation of transportation and childcare costs during treatment,” the researchers wrote.