Association Between Rurality and Race/Ethnicity and Pediatric Cancer Early Mortality: A Population-Based Cohort Study Using SEER Data from 2000 to 2021

Abstract

Background

Pediatric cancer mortality rates have steadily declined since 2009, but over a thousand deaths still occur annually. While existing research highlights the effects of race/ethnicity and rurality on overall survival, few studies have specifically analyzed these factors in relation to early mortality, defined as death within 12 months of diagnosis.

Procedure

This study utilized SEER Research Plus Limited-Field Data (2000–2021) to examine the association between race/ethnicity, rurality, and early mortality in pediatric cancer patients. A cohort of 138,648 individuals was analyzed using Cox proportional hazards regression models to calculate hazard ratios and 95% confidence intervals (CIs).

Results

The results demonstrated that both race/ethnicity and rurality were significantly associated with early mortality. Non-Hispanic Black patients were 70% (95% CI: 1.60–1.82) more likely to die within the first year of diagnosis compared to non-Hispanic Whites, and other racial/ethnic groups also saw significant associations. The adjusted hazard ratio for early mortality compared to urban counties greater than 1 million was significant (p < 0.05) for all degrees of rurality. Pediatric cancer patients in rural counties not adjacent to urban counties had the highest risk of early mortality, 27% (95% CI: 1.13–1.42), within 1 year of diagnosis. A subanalysis of adolescent patients also showed similar patterns.

Conclusions

These findings emphasize the need to address disparities in early mortality for pediatric cancer patients, particularly among racial/ethnic minorities and those in rural communities.