Is mortality after childhood cancer dependent on social or economic resources of parents? A population‐based study

Abstract

Diagnostic and treatment protocols for childhood cancer are generally standardized, and therefore, survival ought to be fairly equal across social strata in societies with free public health care readily available. Nevertheless, our study explores whether there are disparities in mortality after childhood cancer in Norway depending on socioeconomic status of parents. Limited knowledge on differentials exists from earlier analyses. Discrete-time hazard regression models for all-cause mortality for the first 10 years after diagnosis were estimated for all Norwegian children (younger than 20 years), who were diagnosed with cancer during 1974-2007 (N 5 6,280), using data from five national registers. Mortality was reduced by about 15% for children with highly educated mothers and children without siblings. These effects were most pronounced for cancers predicted to encompass intense, long-lasting treatments resulting in chronic health problems. Neither earnings nor the marital status of parents affected children's survival. This large, registry-based study suggests that time constraints and various noneconomic rewards of parents from their education appears to have an impact on childhood cancer survival. It may be that children with resourceful parents are healthier at the outset and/or are more likely to avoid later health problems. It may also be that children of well-informed and strongly involved parents are offered better treatment or are able to make better use of what is offered, for instance, by adhering more closely to recommendations for follow-up treatment. The possibility of such differentials in offered and actual treatment should be addressed in future research.

Effect of socioeconomic position on survival after childhood cancer in Denmark

“…Most of the available studies included only children with acute lymphoblastic leukemia or hematological cancer in general, with inconsistent results for a range of socioeconomic position indicators; some finding differences in survival [5][6][7][8] and others no differences [9][10][11]. To our knowledge, the only previous study including childhood cancers at all sites was a Norwegian population-based study of 6280 childhood cancer patients with a mean follow-up of 6.7 years reporting reduced mortality rates from cancers that require lengthy treatment [tumors in the central nervous system (CNS), leukemia, neuroblastomas, and bone tumors] among children whose mothers had higher education or who had no siblings [12].…”

“…The associations between better survival and higher maternal education and being an only child were seen mainly for children with non-CNS solid tumors, whereas the association between having parents who live together and survival was attributable mainly to a protective effect in children with CNS tumors and less so in children with non-CNS solid tumors. These findings are partly in line with those of a Norwegian study of 6280 children with cancer of all types diagnosed between 1974 and 2007, in which the mother's educational level and the number of siblings were associated with survival after cancers with longterm treatment (CNS tumors, leukemia, neuroblastomas, and bone tumors) [12]. They did not find an association between parental marital status and survival, although their definition did not include unmarried parents living together, which in our study constituted some 19%.…”

Cancer Illness in Children and the Socioeconomic Resources of Parents

“…The chapter will therefore also summarize and discuss research on the influence of parental resources or socioeconomic status more generally on mortality after childhood cancer in a society with presumably equal access to high quality cancer care. Empirical findings from a recent Norwegian study will then follow (21). Lastly, a summary of the current status of knowledge in this field is provided, and areas where further research is warranted are highlighted.…”

Socioeconomic status (SES) and childhood acute myeloid leukemia (AML) mortality risk: Analysis of SEER data

“…These studies have examined individually-based indices such as parental occupation, maternal education and household income [4,6,7] and community-level variables such as poverty and unemployment rates, educational attainment, median household income and crowding [5,8, 22]. Typically such indices are either examined separately, in some form of composite (e.g., summed, averaged), or simultaneously in predictive models, ignoring correlations among variables.…”