Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study

Abstract

Background While underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark. Methods We identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage. Results We found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease. Conclusion Families with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.

Socioeconomic background affects mortality in Danish children with severe chronic disease

“…Prematurity and birth asphyxia are leading causes of child mortality worldwide, and the influence of socioeconomic factors is well‐known, also in high‐income settings as the Nordic countries, and perhaps especially in Denmark. 15 , 16 Thus, the present results followed the general pattern to some extent.…”

“…Second, Pedersen et al found that among Danish children with cancer, families with socioeconomic disadvantage, non‐Western origin or depression were more frequent users of pre‐diagnostic healthcare services. 16 This indicated that even in the high‐income setting of Denmark, some families struggle to navigate in the healthcare system even when their child is severely ill.…”

“…Thus, inferior physician compliance to protocol recommendations of anti‐cancer treatment could partly explain the larger social inequality in cancer patients observed in the present study. Second, Pedersen et al found that among Danish children with cancer, families with socioeconomic disadvantage, non‐Western origin or depression were more frequent users of pre‐diagnostic healthcare services 16 . This indicated that even in the high‐income setting of Denmark, some families struggle to navigate in the healthcare system even when their child is severely ill.…”

Early mortality in children with cancer in Denmark and Sweden: The role of social background in a setting with universal healthcare

“…Although there were some statistically significant findings, there were no clear patterns and inclusion of these clinical characteristics in the regression models of early mortality did not appreciably change effect estimates. Two previous studies assessed the association between socioeconomic status or parental education, and white blood cell count among children with leukaemia, and observed no associations, 26,27 although children of single parents were more likely to have a higher white blood cell count. 27 The first symptoms of childhood cancer are often few and unspecific, 28 and an increased utilization of primary care has been documented already several months before the diagnosis.…”

‘Am I that bad?’: Middle‐class moralism and weight stigma towards parents of children with higher weight

“…Studies show that lower-class parents need significantly more consultations than parents of higher socioeconomic status to obtain a cancer diagnosis. At the same time, children of parents who are unemployed or have low education levels generally receive lower doses of chemotherapy (Pedersen, Erdmann, et al, 2021). Because discrimination is highly taboo and very often happens unconsciously, we know extremely little about why and how these inequalities occur.…”