Background
Although acute lymphoblastic leukemia (ALL) 5 years survival in minors has reached 90%, socioeconomic differences have been reported among and within countries. Within countries, the difference has been related to the socioeconomic status of the parents, even in the context of public health services with universal coverage. In Mexico, differences in the mortality of children with cancer have been reported among sociodemographic zones. The Instituto Mexicano del Seguro Social (IMSS), the country’s main social security institution, has reported socioeconomic differences in life expectancy within its affiliated population. Here, the socioeconomic inequalities in the survival of children (< 15 years old) enrolled in the IMSS were analyzed.
Methods
Five-year survival data were analyzed in cohorts of patients diagnosed with ALL during the period 2007–2009 in the two IMSS networks of medical services that serve 7 states of the central region of Mexico. A Cox proportional risk model was developed and adjusted for the socioeconomic characteristics of family, community of residence and for the clinical characteristics of the children. The slope of socioeconomic inequality of the probability of dying within five years after the diagnosis of ALL was estimated.
Results
For the 294 patients studied, the 5 years survival rate was 53.7%; the median survival was 4.06 years (4.9 years for standard-risk diagnosis; 2.5 years for high-risk diagnosis). The attrition rate was 12%. The Cox model showed that children who had been IMSS-insured for less than half their lives had more than double the risk of dying than those who had been insured for their entire lives.
Conclusions
We did not find evidence of socioeconomic inequalities in the survival of children with ALL associated with family income, educational and occupational level of parents. However, we found a relevant gradient related social security protection: the longer children’s life insured by social security, the higher their probability of surviving ALL was. These results add evidence of the effectiveness of social security, as a mechanism of wealth redistribution and a promoter of social mobility. Extending these social security benefits to the entire Mexican population could promote better health outcomes.
Electronic supplementary material
The online version of this article (10.1186/s12939-019-0940-3) contains supplementary material, which is available to authorized users.
This study analyzes the potential economic benefits of identifying and treating patients with so-called prediabetes and prehypertension through the Mexican prevention program known by its Spanish acronym PREVENIMSS. The results show that for each US dollar invested in prevention, $84-$323 would be saved over a twenty-year period. For this and other reasons, providing preventive care for prediabetes and prehypertension patients is better than the current routine care model, in which care is provided in most cases when the disease has progressed substantially. Yet data show that screening and preventive care services are still not being used widely enough in Mexico, are provided too late, or are not sufficiently targeted to the most at-risk individuals. Investing in preventive care for patients with prediabetes and prehypertension is cost saving.
Incidences of HL subtypes differed in relation to socioeconomic conditions in Mexico. In the south, the incidence of mixed cellularity was higher and there was an earlier peak of presentation.
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