Socioeconomic Disparities In Childhood Cancer Survival In Switzerland

Martin ADAM, University of Basel, Switzerland
RUEEGG C. 3,4 , SCHMIDLIN K. 3 , SPOERRI A. 3 , NIGGLI F. 5 , GROTZER M. 5 , VON DER WEID N. 6 , EGGER M. 3 , PROBST-HENSCH N. 1,2 , ZWAHLEN M. 3 , CLAUDIA K. 3

1 Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
2 University of Basel, 4001 Basel, Switzerland
3 Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
4 Department of Biostatistics, University of Oslo, 0316 Oslo, Norway
5 Pediatric Hematology-Oncology Unit, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
6 Pediatric Hematology-Oncology Unit, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland

Purpose: 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).

Methods: 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.

Results: 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).

Conclusions: Even in Switzerland with a high quality health care system and mandatory health insurance, socioeconomic differences in childhood cancer survival persist. This study showed a socioeconomic deprivation gap in 5-year mortality of Swiss children with CNS tumors, with mortality being almost twice as high in children from not well-educated fathers. 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.

Ref: Adam M*, Rueegg CS*, Schmidlin K, et al. Socioeconomic Disparities in Childhood Cancer Survival in Switzerland. International Journal of Cancer; 2016: in press
*both authors contributed equally

Funding sources: This work was supported by Oncosuisse (OCS – 01869 – 02 – 2006, KLS 01869-02-2006) and the Swiss National Science Foundation (Prosper 3233-069348 to CK, and SNC (3347CO-108806, 33CS30_134273 and 33CS30_148415)).