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Survival from childhood acute lymphoblastic leukaemia in West Germany: does socio-demographic background matter?
Friederike Erdmann1, Peter Kaatsch2, Hajo Zeeb3
1Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
Insights
Socio-economic factors did not impact childhood acute lymphoblastic leukemia (ALL) survival in German children. This study found no link between family income or parental education and survival rates, offering reassurance against social inequalities in pediatric cancer care.
Area of Science:
- Pediatric Oncology
- Epidemiology
- Health Services Research
Background:
- Established predictors of childhood acute lymphoblastic leukemia (ALL) survival include sex, age, immunophenotype, and white blood cell count.
- The influence of socio-economic determinants on pediatric ALL survival remains less understood, particularly in specific national contexts like Germany.
Purpose of the Study:
- To investigate the relationship between socio-economic factors and survival outcomes in German children diagnosed with acute lymphoblastic leukemia (ALL).
- To determine if family income or parental education level affects overall survival or event-free survival in pediatric ALL patients.
Main Methods:
- Utilized data from a nationwide case-control study of ALL cases diagnosed between 1992-1994 in Germany.
- Employed Cox proportional hazards models to analyze the impact of socio-demographic characteristics on survival over a 10-year follow-up period.
- Assessed overall survival and event-free survival, considering factors like age at diagnosis, sex, family income, and parental education.
Main Results:
- Overall survival for childhood ALL was 82.5%, with a slightly higher survival rate observed in girls (85%) compared to boys (81%).
- A non-linear association between age at diagnosis and survival was noted, with poorer outcomes in infants and children over 5 years old.
- Crucially, no significant association was found between socio-economic factors (family income, parental education) and either survival or risk of relapse.
Conclusions:
- Socio-economic determinants did not appear to influence acute lymphoblastic leukemia (ALL) survival in West German children, contrasting with findings from some other countries.
- Potential reasons for these differences may include variations in social welfare systems, healthcare access, lifestyle, and treatment protocols.
- While reassuring, the absence of social inequalities in pediatric ALL survival warrants ongoing monitoring due to evolving treatments and healthcare services.
Background:
Sex, age, immunophenotype and white blood cell count at diagnosis are well accepted predictors of survival from acute lymphoblastic leukaemia (ALL) in children. Less is known about the relationship between socio-economic determinants and survival from paediatric ALL, studied here for the first time in German children.
Methods:
ALL cases were diagnosed between 1992 and 1994 and their parents interviewed during a previous nationwide case-control study. Children were followed-up for 10 years after diagnosis by the German Childhood Cancer Registry. Cox proportional hazards models estimating hazard ratios (HRs) were calculated to assess the impact of selected socio-demographic characteristics on overall and event-free survival.
Results:
Overall survival was 82.5%, with a higher proportion of girls than boys surviving (85% versus 81%). We found a non-linear relationship between age at diagnosis and survival, with poorer survival in infants and children aged >5 years. There was no association between socio-economic factors and survival or risk of relapse. For five levels of increasing family income, all HRs were close to one. No relationship was seen with parental educational level.
Conclusion:
Socio-economic determinants did not affect ALL survival in West German children, in contrast to studies from some other countries. Dissimilarities in social welfare systems, including access to health care, lifestyle and differences in treatment may contribute to these differences in findings. Our observation of no social inequalities in paediatric ALL survival is reassuring, but needs continued monitoring to assess the potential impact of evolvement of treatment options and changes in paediatric health service.
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