Artikel
Socioeconomic background and childhood cancer survival in Germany – a nationwide assessment based on data from the German Childhood Cancer Registry
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Autoren
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Maike Wellbrock
- Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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Arndt Borkhardt
- Department of Paediatric Oncology, Haematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany; German Cancer Consortium (DKTK), partnering site Essen/Düsseldorf, Düsseldorf, Germany
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Cécile M Ronckers
- Division of Childhood Cancer Epidemiology/ German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Claudia Spix
- Division of Childhood Cancer Epidemiology/ German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Desiree Grabow
- Division of Childhood Cancer Epidemiology/ German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology/ German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Daniel Wollschläger
- Division of Epidemiological Methodology and Radiation Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Friederike Erdmann
- Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| Veröffentlicht: | 6. September 2024 |
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Gliederung
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Background: Since the 1960s, survival after childhood cancer has improved remarkably. However, evidence is accumulating that not all children with cancer have benefitted equally from diagnostic and therapeutic improvements and that socioeconomic conditions are also associated with prognosis – even in high-income countries within Europe where equal access to health care is presumed. We investigated the association between area-based socioeconomic background and survival from childhood cancer in Germany with the ultimate aim to identify groups of children that may benefit from supportive interventions and additional care.
Methods: Using data from the German Childhood Cancer Registry (GCCR), we identified all children with a cancer diagnosis before the age of 15 years in 1997-2016 in Germany (N=35,443). Based on individual residential address information (at time of diagnosis) we applied the German Index of Socioeconomic Deprivation as measure of area-based socioeconomic status (SES). Using multivariable Cox proportional hazards models (adjusted for year of diagnosis, year of birth and place of residence), we assessed the association between absolute area-based socioeconomic deprivation (AASD) and ten-year overall survival (OS). In additional analysis, we assessed the association between three selected single area-based SES indicators (household net income, unemployment rate, and proportion of employees with university degree) and ten-year OS.
Results: The multivariable analyses revealed a null association for AASD and ten-year OS for all cancers combined (HRadj=1.00, 95% CI 0.97; 1.03). However, besides tendencies of age- and sex-specific differences, the cancer type-specific analysis indicated worse survival from acute myeloid leukaemia (AML) and germ cell tumours for children who resided in regions with higher AASD (implying more severe levels of deprivation) (HRadj=1.10 (95% CI 0.98; 1.23) and HRadj=1.29 (95% CI 0.98; 1.69), respectively). The opposite pattern was observed among children diagnosed with CNS tumours, in that low AASD were associated with worse survival.
The single indicator-specific analyses found survival from AML to be lower among children who resided in regions of lower area-based household net income and lower proportion of employees with a university degree. For children with CNS tumours, results indicated that both lower household net income and higher unemployment rate were associated with higher ten-year OS.
Discussion: We found little evidence for pronounced social inequalities in childhood cancer survival in Germany based on a composite score, with however inconsistent patterns across cancer types, area-based SES measures, and age at diagnosis. Further research assessing individual-level measures of socioeconomic status is warranted.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
