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Social gradient predicts survival disadvantage of African Americans/Black children with lymphoma
Laurens Holmes1, Malik A Williams2, Daniel R Halloran1
1Nemours Children's Healthcare System-Translation Health Disparities Science Research, Wilmington, DE, United States; Biological Sciences Department, University of Delaware, Newark, DE, United States.
Insights
Black children with lymphoma face higher mortality and survival disadvantages compared to white children. Socioeconomic factors like urbanity and income contribute to these disparities, highlighting the need for environmental improvements.
Area of Science:
- Pediatric Oncology
- Epidemiology
- Health Disparities
Background:
- Childhood cancer, particularly lymphoma, is a leading cause of mortality in children.
- Lymphoma affects lymphoid cells, including B and T cells, and is common in pediatric populations.
- Understanding cumulative incidence, mortality, and survival is crucial for pediatric lymphoma management.
Purpose of the Study:
- To assess the cumulative incidence (CmI) of pediatric lymphoma.
- To evaluate mortality rates and survival outcomes in children diagnosed with lymphoma.
- To investigate the influence of social determinants of health on pediatric lymphoma outcomes.
Main Methods:
- Retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data.
- Inclusion of children aged 0-19 years diagnosed with lymphoma.
- Analysis of social determinants including urbanity, median household income, and race, using chi-square, binomial regression, and Cox proportional hazard models.
Main Results:
- Cumulative incidence was highest among white children (76.67%) compared to other racial groups.
- Black/African American (AA) children experienced excess mortality (RR=1.54) and a higher likelihood of death (HR=1.52) compared to white children.
- A survival disadvantage persisted among Black/AA children even after adjusting for confounders (aHR=1.54).
Conclusions:
- Black/AA children with lymphoma exhibit a significant survival disadvantage relative to white children.
- Urbanity and median household income were identified as factors contributing to racial differences in survival.
- Addressing environmental and socioeconomic factors is essential to reduce racial disparities in pediatric lymphoma survival.
Background:
Cancer is the leading cause of disease-related mortality among children, 0-14 years, and lymphoma, a malignant neoplasm of the lymphoid cells, mostly lymphatic B and T cells is common among children. The current study aimed to assess the cumulative incidence (CmI), mortality, and survival in pediatric lymphoma.
Materials And Methods:
A retrospective cohort was utilized to examine children, 0-19 years with lymphoma for CmI, mortality and survival from the Surveillance, Epidemiology, and End Results (SEER) data. The variables assessed included social determinants of health, namely urbanity, median household income, and race. While chi square was used to characterize study variables by race, binomial regression was employed for mortality risk. The Cox proportional hazard model was used for survival modeling.
Results:
The CmI was higher among white children (76.67%) relative to Black/African American (AA, 13.44%), American Indian/Alaskan Native (AI/AN, 0.67%), as well as Asian/Pacific Islander (A/PI, 7.53%). With respect to mortality, there was excess mortality among Black/AA children compared to white children, Risk Ratio (RR) = 1.54, 95% CI, 1.33-1.79. Relative to whites, Blacks were 52% more likely to die, Hazard Ratio (HR) = 1.52, 95% CI, 1.30-1.78. Survival disadvantage persisted among Blacks/AA after controlling for the other confoundings, adjusted hazard ratio (aHR) = 1.54, 99% CI, 1.24-1.91.
Conclusion:
In a large cohort of children with lymphoma, Black/AA children relative to whites presented with survival disadvantage, which was explained by urbanity and median household income, suggestive of transforming the physical and social environments in narrowing the racial differences in pediatric lymphoma survival in the US.
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