The Role of Childhood Opportunity in Acute Lymphoblastic Leukemia Survival in New Jersey: 2004-2020

Area of Science:

• Pediatric Oncology
• Health Equity Research
• Social Determinants of Health

Background:

• Neighborhood resource disparities in the US perpetuate health inequities.
• Policies have historically created unequal access to resources for children.
• These imbalances contribute to significant health disparities.

Purpose of the Study:

• To investigate the association between neighborhood resources, using the Child Opportunity Index, and overall survival in pediatric acute lymphoblastic leukemia (ALL) patients in New Jersey.
• To identify specific neighborhood-level factors influencing survival outcomes.
• To inform targeted interventions for improving pediatric cancer care.

Main Methods:

• Utilized the New Jersey State Cancer Registry to identify 1,343 children and adolescents diagnosed with ALL (2004-2020).
• Employed Kaplan-Meier survival analysis and log-rank tests to compare survival across Child Opportunity Index categories.
• Used Cox proportional hazards regression models to assess the risk of death, adjusting for relevant factors.

Main Results:

• Overall five-year survival for pediatric ALL was 90%.
• Children in very low opportunity census tracts had a 2.6-fold increased risk of death compared to those in very high opportunity tracts.
• Survival rates were 87% in very low opportunity tracts versus 96% in very high opportunity tracts.
• Disparities were primarily driven by socioeconomic factors, not race or ethnicity.

Conclusions:

• Childhood acute lymphoblastic leukemia survival in New Jersey is partly determined by inequitable neighborhood resource allocation.
• Children residing in under-resourced areas face the greatest risk.
• Addressing socioeconomic disparities in neighborhood opportunity is crucial for improving pediatric cancer outcomes.