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“Despite significant progress in the treatment of pediatric cancer, socioeconomic factors continue to cause outcome disparities, including lower five-year survival among children with malignant solid tumors who live in socioeconomically disadvantaged neighborhoods compared to those from more affluent areas,” said study co-author Dai Chung, M.D., Professor of Surgery at UT Southwestern and Chief Medical Executive at Children’s Health.
Low socioeconomic status is a well-established factor associated with poor health outcomes for children. In this study, Dr. Chung and his team evaluated Texas Cancer Registry records of 3,863 children diagnosed with malignant tumors between 1995 and 2019. The average age at diagnosis was 4.5 years.
The researchers’ primary outcome measure was to determine overall patient survival after five years. However, since pediatric malignant tumors often metastasize before they’re found, the team also evaluated for delays in diagnosis and treatment, which can affect patient survival.
UTSW researchers used the Area Deprivation Index (ADI), which measures 17 neighborhood socioeconomic characteristics, including education levels and housing availability, to assess patients’ backgrounds. Higher ADI scores indicate greater economic uncertainty. They compared ADI scores and other patient demographic information, including sex, race, ethnicity, and household location, to determine the effects on clinical outcomes.
Dr. Chung and colleagues found that non-white pediatric cancer patients had a higher risk of death than their white counterparts. The study showed that with each point increase in ADI, the risk of death within five years of diagnosis increased by 4%.
Minority patients living in affluent neighborhoods also had an increased risk of death compared with the overall risk for patients with the lowest ADI scores. Rural and impoverished patients residing in affluent counties in Texas also had higher mortality rates at year five after diagnosis.
During the study period, 52% of the children with solid tumors were diagnosed with metastatic cancer. Those who lived in affluent pockets surrounded by impoverished neighborhoods, non-white children, and those living in rural areas or areas near the Texas-Mexico border had an increased risk of metastatic disease.
Lower socioeconomic status was also associated with later treatment initiation, which can increase the risk of cancer metastasis and death. Among sarcoma patients, for example, the median time between diagnosis and the start of treatment for all children in the study was three days. But the investigators found that treatment began more than 51 days later among Black patients compared with white patients. Children living in rural counties began treatment 34 days later than those living in metropolitan areas, the study showed.
“Determining which populations are at the highest risk and where to direct resources can be difficult,” Dr. Chung explained. “Our hope is that our study findings can motivate improvements in racial and socioeconomic diversity in pediatric cancer clinical trials, increase funding for disparities in outcomes research, and implement ground-level changes that will make health care more accessible for all patients.”
Other UTSW investigators who contributed to this study are first author Elizabeth D. Cochran, M.D., a general surgical resident who recently completed a pediatric research fellowship in Dr. Chung’s lab; Jingbo Qiao, Ph.D., Assistant Professor of Surgery; and Jillian Jacobson, M.D., a general surgery resident. Sullivan McCreery, B.A., a medical student at UT-Health Houston McGovern Medical School, and Mithin Nehrubabu, B.S., from the Department of Mathematical Sciences at the University of Dallas, also contributed to this work.
This study was supported by a grant from the National Institutes of Health (R01 DK61470).
Dr. Chung holds the Helen J. and Robert S. Strauss and Diana K. and Richard C. Strauss Chair in Pediatric Surgery.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 25 members of the National Academy of Sciences, 21 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.
