O3280: Social Determinants of Health Are Associated with Worse Overall Survival in Children with Cancer

Background: While significant advancements have been made in the diagnosis and treatment of pediatric cancer, social determinants of health (SDOH) have a significant impact on cancer outcomes. The aim of this study was to assess the impact of SDOH factors on the survival rates of children with cancer.

Methods: The National Cancer Database was used to conduct a retrospective cohort study of children < 18 years old with any malignant cancer between 2004 and 2019. Social determinants of health (SDOH) factors included race, ethnicity, parental levels of education, median household income, area of residence, distance to facility, and insurance status. Survival analysis was performed by SDOH using Kaplan-Meier methods and Cox Proportional Hazard Survival Regression.

Results: A total of 144,794 patients (median age 8 years) were included, with 46.31% female and 53.59% male. 112,965 (78.02%) identified as white, 16,427 (11.35%) as black, and 25,415 (17.55%) had a Hispanic ethnicity. On multivariate Cox proportional regression, SDOH factors associated with a worse 5-year survival were black race (versus white race) (5-year Overall Survival (OS) 81% vs. 86%, HR 1.30, 95% CI 1.24-1.36,P < 0.001), Hispanic ethnicity (OS 84% vs. 86%, HR 1.07, 95% CI 1.03-1.12,P=0.002), low level of parental education (OS 84% vs. 86%, HR 1.2, 95% CI 1.12-1.27,P < 0.001), non-private insurance (OS 83% vs. 87% in private insurance, HR 1.17, 95% CI 1.17-1.42 , P< 0.001), no insurance (OS 81% vs. 87%, HR 1.42, 95% CI 1.29-1.57, P< 0.001), and living >60 miles from treating facility (OS 82% vs. 86%, HR 1.21, 95% CI 1.16-1.26,P < 0.001).

Conclusion: In conclusion, our study highlights the critical role of SDOH on the survival rates of children with cancer. Among all cancer types, decreased overall survival was found in children who are black or Hispanic, have parents with low levels of education, and non-private or no insurance. It is important to address these factors in order to achieve equity in pediatric cancer outcomes. Further research is needed to explore effective interventions that can mitigate these disparities.