Territorial Socioeconomic Vulnerability and Clinical Outcomes in Pediatric Cancer at a Colombian Referral Center

Background/Objectives: Childhood cancer outcomes are influenced by clinical, socioeconomic, and territorial factors, particularly in resource-limited settings. This study characterized pediatric cancer patients from Córdoba and Sucre, Colombia, and evaluated factors associated with clinical outcomes in a regional referral center. Methods: A retrospective hospital-based study included 434 patients aged 0-18 years diagnosed between 2018 and 2024. Sociodemographic, clinical, and territorial socioeconomic variables were analyzed using the Multidimensional Poverty Index (MPI). Clinical outcomes were classified as favorable, non-favorable, or death. Firth-penalized logistic regression models were used to assess adjusted associations. Results: Hematologic malignancies predominated (65.9%), with acute lymphoblastic leukemia as the most frequent diagnosis. Most patients came from municipalities with moderate or high multidimensional poverty (85.2%), and the rural territories of origin showed greater deprivation in education, employment, housing, water access, and sanitation. Favorable outcomes occurred in 82.9% of patients, while 8.5% had non-favorable outcomes and 8.5% died. Older age and non-hematologic malignancies were associated with non-favorable outcomes. Mortality was associated with older age, subsidized health insurance, and non-hematologic malignancies. MPI and rural residence were not independently associated with outcomes after adjustment. Conclusions: Although MPI was not independently associated with clinical outcomes, it identified substantial territorial deprivation. Integrating clinical and territorial indicators may support equity-oriented surveillance and pediatric oncology interventions.