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The association between socioeconomic status and survival among children with Hodgkin and non-Hodgkin lymphomas in a universal health care system

Authors

  • Denise Darmawikarta MPH,

    1. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
    2. Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
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  • Jason D. Pole PhD,

    Corresponding author
    1. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
    2. Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
    • Pediatric Oncology Group of Ontario, 1040-480 University Ave, Toronto, ON, Canada M5G 1V2.
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  • Sumit Gupta MD,

    1. Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Paul C. Nathan MSc, MD,

    1. Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Mark Greenberg MB, ChB

    1. Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
    2. Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Conflict of interest: Nothing to declare.

Abstract

Background

The association between socioeconomic status (SES) and cancer survival has been studied extensively in adults. However, little is known about this relationship in the pediatric population, specifically in jurisdictions with universal health care insurance programs. Our aim was to determine whether lower SES is associated with poorer survival in pediatric Hodgkin (HL) and non-Hodgkin lymphoma (NHL) patients in Ontario.

Procedure

All incident cases of HL and NHL in children between 0 and 14 years old diagnosed in Ontario between January 1st, 1985 and December 31st, 2006 were identified through the Pediatric Oncology Group of Ontario Networked Information System. Neighborhood income quintile and material deprivation quintile at diagnosis were used as proxies for SES. Cox proportional hazards regressions were used to assess the association between SES and the risk of event-free or overall survival.

Results

A total of 692 patients were included in the analysis: 302 HL and 390 NHL. SES was not associated with survival (overall or event-free) among HL and NHL patients (P > 0.05 for all four comparisons, i.e., HL/NHL, EFS/OS) after adjustment for age, sex, period of diagnosis, and disease stage. There were no differences in the distribution of disease stage across SES strata at the time of diagnosis. Similarly, the distribution of deaths among long-term survivors (survived ≥5 years from diagnosis) did not differ across SES strata (P > 0.05).

Conclusions

SES was not associated with risk of death among pediatric HL and NHL patients in Ontario. This was consistent through the cancer trajectory, including diagnosis, treatment, and survivorship. Pediatr Blood Cancer 2013; 60: 1171–1177. © 2012 Wiley Periodicals, Inc.

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