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Does socioeconomic status account for racial and ethnic disparities in childhood cancer survival?
Cancer 2018; 124(20):4090-4097C

Abstract

BACKGROUND

For many childhood cancers, survival is lower among non-Hispanic blacks and Hispanics in comparison with non-Hispanic whites, and this may be attributed to underlying socioeconomic factors. However, prior childhood cancer survival studies have not formally tested for mediation by socioeconomic status (SES). This study applied mediation methods to quantify the role of SES in racial/ethnic differences in childhood cancer survival.

METHODS

This study used population-based cancer survival data from the Surveillance, Epidemiology, and End Results 18 database for black, white, and Hispanic children who had been diagnosed at the ages of 0 to 19 years in 2000-2011 (n = 31,866). Black-white and Hispanic-white mortality hazard ratios and 95% confidence intervals, adjusted for age, sex, and stage at diagnosis, were estimated. The inverse odds weighting method was used to test for mediation by SES, which was measured with a validated census-tract composite index.

RESULTS

Whites had a significant survival advantage over blacks and Hispanics for several childhood cancers. SES significantly mediated the race/ethnicity-survival association for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma; SES reduced the original association between race/ethnicity and survival by 44%, 28%, 49%, and 34%, respectively, for blacks versus whites and by 31%, 73%, 48%, and 28%, respectively, for Hispanics versus whites ((log hazard ratio total effect - log hazard ratio direct effect)/log hazard ratio total effect).

CONCLUSIONS

SES significantly mediates racial/ethnic childhood cancer survival disparities for several cancers. However, the proportion of the total race/ethnicity-survival association explained by SES varies between black-white and Hispanic-white comparisons for some cancers, and this suggests that mediation by other factors differs across groups.

Authors+Show Affiliations

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota.National Cancer Institute, Bethesda, Maryland. Epidemiology Branch, Prevention and Population Sciences Program, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30125340

Citation

Kehm, Rebecca D., et al. "Does Socioeconomic Status Account for Racial and Ethnic Disparities in Childhood Cancer Survival?" Cancer, vol. 124, no. 20, 2018, pp. 4090-4097.
Kehm RD, Spector LG, Poynter JN, et al. Does socioeconomic status account for racial and ethnic disparities in childhood cancer survival? Cancer. 2018;124(20):4090-4097.
Kehm, R. D., Spector, L. G., Poynter, J. N., Vock, D. M., Altekruse, S. F., & Osypuk, T. L. (2018). Does socioeconomic status account for racial and ethnic disparities in childhood cancer survival? Cancer, 124(20), pp. 4090-4097. doi:10.1002/cncr.31560.
Kehm RD, et al. Does Socioeconomic Status Account for Racial and Ethnic Disparities in Childhood Cancer Survival. Cancer. 2018 10 15;124(20):4090-4097. PubMed PMID: 30125340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does socioeconomic status account for racial and ethnic disparities in childhood cancer survival? AU - Kehm,Rebecca D, AU - Spector,Logan G, AU - Poynter,Jenny N, AU - Vock,David M, AU - Altekruse,Sean F, AU - Osypuk,Theresa L, Y1 - 2018/08/20/ PY - 2017/12/08/received PY - 2018/01/11/revised PY - 2018/02/02/accepted PY - 2018/8/21/pubmed PY - 2019/9/24/medline PY - 2018/8/21/entrez KW - cancer survival KW - childhood cancer KW - mediation KW - racial and ethnic disparities KW - socioeconomic status SP - 4090 EP - 4097 JF - Cancer JO - Cancer VL - 124 IS - 20 N2 - BACKGROUND: For many childhood cancers, survival is lower among non-Hispanic blacks and Hispanics in comparison with non-Hispanic whites, and this may be attributed to underlying socioeconomic factors. However, prior childhood cancer survival studies have not formally tested for mediation by socioeconomic status (SES). This study applied mediation methods to quantify the role of SES in racial/ethnic differences in childhood cancer survival. METHODS: This study used population-based cancer survival data from the Surveillance, Epidemiology, and End Results 18 database for black, white, and Hispanic children who had been diagnosed at the ages of 0 to 19 years in 2000-2011 (n = 31,866). Black-white and Hispanic-white mortality hazard ratios and 95% confidence intervals, adjusted for age, sex, and stage at diagnosis, were estimated. The inverse odds weighting method was used to test for mediation by SES, which was measured with a validated census-tract composite index. RESULTS: Whites had a significant survival advantage over blacks and Hispanics for several childhood cancers. SES significantly mediated the race/ethnicity-survival association for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma; SES reduced the original association between race/ethnicity and survival by 44%, 28%, 49%, and 34%, respectively, for blacks versus whites and by 31%, 73%, 48%, and 28%, respectively, for Hispanics versus whites ((log hazard ratio total effect - log hazard ratio direct effect)/log hazard ratio total effect). CONCLUSIONS: SES significantly mediates racial/ethnic childhood cancer survival disparities for several cancers. However, the proportion of the total race/ethnicity-survival association explained by SES varies between black-white and Hispanic-white comparisons for some cancers, and this suggests that mediation by other factors differs across groups. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/30125340/Does_socioeconomic_status_account_for_racial_and_ethnic_disparities_in_childhood_cancer_survival L2 - https://doi.org/10.1002/cncr.31560 DB - PRIME DP - Unbound Medicine ER -