Persistent Poverty and Pediatric Cancer Survival.

Abstract

BACKGROUND Cancer is the leading cause of death by disease among US children. While previous studies have examined the impact of poverty on pediatric cancer outcomes, most relied on single time point measures, which may not capture the long-term, systemic effects of poverty. Persistent poverty, defined as having 20% or more of an area's population below the poverty level for 30 years, represents a more comprehensive measure of sustained socioeconomic disadvantage. METHODS In this population-based study, we used Surveillance, Epidemiology, and End Results (SEER)-22 Registries Incidence Data with Census Tract Attributes Database data. Primary cases of cancer diagnosed among children from 2006 to 2020 were included. Cox proportional hazards models were used to compute the association between persistent poverty and (1) early mortality (death from cancer within 3 months of diagnosis) and (2) overall cancer-specific mortality. RESULTS In total, 97 132 children were included in our study; 12.63% resided in a persistent-poverty neighborhood at diagnosis. In the adjusted models, living in a persistent-poverty neighborhood was associated with a higher risk of early mortality (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.10-1.45) and a higher risk of overall cancer death (aHR, 1.15; 95% CI, 1.10-1.21). Persistent poverty was associated with survival for children with leukemias (aHR, 1.20; 95% CI, 1.09-1.31), central nervous system tumors (aHR, 1.14; 95% CI, 1.04-1.26), and hepatic tumors (aHR, 1.37; 95% CI, 1.01-1.85). CONCLUSIONS Our study observed increased risk of cancer death among children in persistent-poverty neighborhoods. Continued investment and research are critical to developing effective strategies that reduce disparities and improve outcomes for pediatric cancer patients affected by persistent poverty.