Socioeconomic disparities in childhood cancer survival in Switzerland

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• 作者：Martin Adam ; Corina S. Rueegg ; Kurt Schmidlin ; Adrian Spoerri ; Felix Niggli ; Michael Grotzer ; Nicolas X. von der Weid ; Matthias Egger ; Nicole Probst-Hensch ; Marcel Zwahlen ; Claudia E. Kuehni and and the Swiss Paediatric Oncology Group (SPOG) and the Swiss National Cohort Study (SNC)
• 关键词：childhood cancer ; mortality ; 5-year survival ; socioeconomic status ; leukemia ; central nervous system tumor
• 刊名：International Journal of Cancer
• 出版年：2016
• 出版时间：15 June 2016
• 年：2016
• 卷：138
• 期：12
• 页码：2856-2866
• 全文大小：295K
• ISSN：1097-0215

文摘

In this study, we investigated whether childhood cancer survival in Switzerland is influenced by socioeconomic status (SES), and if disparities vary by type of cancer and definition of SES (parental education, living condition, area-based SES). Using Cox proportional hazards models, we analyzed 5-year cumulative mortality in all patients registered in the Swiss Childhood Cancer Registry diagnosed 1991–2006 below 16 years. Information on SES was extracted from the Swiss census by probabilistic record linkage. The study included 1602 children (33% with leukemia, 20% with lymphoma, 22% with central nervous system (CNS) tumors); with an overall 5-year survival of 77% (95%CI 75–79%). Higher SES, particularly parents' education, was associated with a lower 5-year cumulative mortality. Results varied by type of cancer with no association for leukemia and particularly strong effects for CNS tumor patients, where mortality hazard ratios for the different SES indicators, comparing the highest with the lowest group, ranged from 0.48 (95%CI: 0.28–0.81) to 0.71 (95%CI: 0.44–1.15). We conclude that even in Switzerland with a high quality health care system and mandatory health insurance, socioeconomic differences in childhood cancer survival persist. Factors causing these survival differences have to be further explored, to facilitate universal access to optimal treatment and finally eliminate social inequalities in childhood cancer survival.