Early mortality in children with cancer in Denmark and Sweden: The role of social background in a setting with universal healthcare.

Autor: Mogensen H; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden., Erdmann F; Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark.; Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany., Mader L; Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark.; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.; Cancer Registry Bern-Solothurn, University of Bern, Bern, Switzerland., Vrelits Sørensen G; Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark., Talbäck M; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden., Tjørnelund Nielsen T; Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark., Hasle H; Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark., Heyman M; Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden., Winther JF; Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark.; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark., Feychting M; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden., Tettamanti G; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden., Kenborg L; Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: International journal of cancer [Int J Cancer] 2024 May 15; Vol. 154 (10), pp. 1719-1730. Date of Electronic Publication: 2024 Jan 23.
DOI: 10.1002/ijc.34851
Abstrakt: Socioeconomic differences in overall survival from childhood cancer have been shown previously, but the underlying mechanisms remain unclear. We aimed to investigate if social inequalities were seen already for early mortality in settings with universal healthcare. From national registers, all children diagnosed with cancer at ages 0-19 years, during 1991-2014, in Sweden and Denmark, were identified, and information on parental social characteristics was collected. We estimated odds ratios (OR) and 95% confidence intervals (CI) of early mortality (death within 90 days after cancer diagnosis) by parental education, income, employment, cohabitation, and country of birth using logistic regression. For children with acute lymphoblastic leukaemia (ALL), clinical characteristics were obtained. Among 13,926 included children, 355 (2.5%) died within 90 days after diagnosis. Indications of higher early mortality were seen among the disadvantaged groups, with the most pronounced associations observed for maternal education (OR adj_Low_vs_High 1.65 [95% CI 1.22-2.23]) and income (OR adj_Q1(lowest)_vs_Q4(highest) 1.77 [1.25-2.49]). We found attenuated or null associations between social characteristics and later mortality (deaths occurring 1-5 years after cancer diagnosis). In children with ALL, the associations between social factors and early mortality remained unchanged when adjusting for potential mediation by clinical characteristics. In conclusion, this population-based cohort study indicated differences in early mortality after childhood cancer by social background, also in countries with universal healthcare. Social differences occurring this early in the disease course requires further investigation, also regarding the timing of diagnosis.
(© 2024 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)
Databáze: MEDLINE
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