Socioeconomic disparities in childhood cancer survival in Switzerland

Authors

  • Martin Adam,

    Corresponding author
    1. Swiss Tropical and Public Health Institute, Basel, Switzerland
    2. University of Basel, Basel, Switzerland
    3. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    • Correspondence to: Dr. Martin Adam, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland, Tel.: +41 61 284 83 96, Fax: +41 61 284 81 05, E-mail: martin.adam@unibas.ch

    Search for more papers by this author
    • M.A. and C.S.R. contributed equally to this work

  • Corina S. Rueegg,

    1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    2. Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
    Search for more papers by this author
    • M.A. and C.S.R. contributed equally to this work

  • Kurt Schmidlin,

    1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    Search for more papers by this author
  • Adrian Spoerri,

    1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    Search for more papers by this author
  • Felix Niggli,

    1. Pediatric Hematology-Oncology Unit, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
    Search for more papers by this author
  • Michael Grotzer,

    1. Pediatric Hematology-Oncology Unit, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
    Search for more papers by this author
  • Nicolas X. von der Weid,

    1. Pediatric Hematology-Oncology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland
    Search for more papers by this author
  • Matthias Egger,

    1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    Search for more papers by this author
  • Nicole Probst-Hensch,

    1. Swiss Tropical and Public Health Institute, Basel, Switzerland
    2. University of Basel, Basel, Switzerland
    Search for more papers by this author
  • Marcel Zwahlen,

    1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    Search for more papers by this author
  • Claudia E. Kuehni,

    1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    Search for more papers by this author
  • and the Swiss Paediatric Oncology Group (SPOG) and the Swiss National Cohort Study (SNC)


Abstract

In this study, we investigated whether childhood cancer survival in Switzerland is influenced by socioeconomic status (SES), and if disparities vary by type of cancer and definition of SES (parental education, living condition, area-based SES). Using Cox proportional hazards models, we analyzed 5-year cumulative mortality in all patients registered in the Swiss Childhood Cancer Registry diagnosed 1991–2006 below 16 years. Information on SES was extracted from the Swiss census by probabilistic record linkage. The study included 1602 children (33% with leukemia, 20% with lymphoma, 22% with central nervous system (CNS) tumors); with an overall 5-year survival of 77% (95%CI 75–79%). Higher SES, particularly parents' education, was associated with a lower 5-year cumulative mortality. Results varied by type of cancer with no association for leukemia and particularly strong effects for CNS tumor patients, where mortality hazard ratios for the different SES indicators, comparing the highest with the lowest group, ranged from 0.48 (95%CI: 0.28–0.81) to 0.71 (95%CI: 0.44–1.15). We conclude that even in Switzerland with a high quality health care system and mandatory health insurance, socioeconomic differences in childhood cancer survival persist. Factors causing these survival differences have to be further explored, to facilitate universal access to optimal treatment and finally eliminate social inequalities in childhood cancer survival.

Ancillary