Hendricks Marc, Cois Annibale, Geel Jennifer, van Heerden Jaques, Dandara Collet, Mohamed Kharnita, Donald Kirsten A, Kruger Mariana
Department of Paediatrics and Child Health, Haematology Oncology Service, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Department of Global Health, Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa.
Pediatr Blood Cancer. 2023 Dec;70(12):e30669. doi: 10.1002/pbc.30669. Epub 2023 Sep 13.
Significantly discrepant survival rates have been documented in single disease childhood cancer cohorts in South Africa; those from higher socioeconomic groups were shown to have a significantly lower risk of death than those from less affluent households. This study aimed to determine the impact of socioeconomic status (SES) on childhood cancer survival using pooled South African data.
Five databases spanning January 2000 to December 2021 were interrogated. SES status was assigned based on a public sector annual household income classification. H0 households (formally unemployed) received free healthcare. H1, H2 and H3 (annual income > United States Dollar [USD] 19,000) households paid for healthcare relative to their income. The Spearman test assessed correlations between SES and disease stage in patients with solid tumours. Hazard ratios were determined using Cox regression modelling. The Kaplan-Meier procedure estimated overall survival (OS).
A total of 1598 children were eligible for analysis; 1269 had a solid tumour with a negative correlation between SES and stage (Spearman rho = -.178; p < .001). Patients with solid tumours and lower SES showed proportionately higher numbers of stage III and IV disease (p < .01). This proportion decreased with higher SES categories. In the multivariate analyses adjusted for sex, age, tumour type and stage, higher SES was associated with lower mortality risk (p < .001), indicating that the impact of SES on survival was in excess of any effect that could be explained by lower stage disease alone. There was a strong positive correlation between race and SES (Fisher's exact tests, p < .001) across all groups and all SES strata. Five-year OS was 85.3% in children from H3 households versus 46.3% in children from H0 households (p < .001).
SES significantly impacts childhood cancer survival for children with solid tumours in South Africa. SES is a robust surrogate for race in South Africa as a prognostic metric of disease outcome in childhood cancer. Advocacy to increase social support for impoverished patients is essential to achieve equitable improvements in outcomes treated with standardised national treatment guidelines.
南非单一疾病儿童癌症队列的生存率差异显著；社会经济地位较高群体的儿童死亡风险显著低于较贫困家庭的儿童。本研究旨在利用南非汇总数据确定社会经济地位（SES）对儿童癌症生存的影响。
对2000年1月至2021年12月期间的五个数据库进行了查询。SES状态根据公共部门家庭年收入分类进行划分。H0家庭（正式失业）可享受免费医疗。H1、H2和H3家庭（年收入>19000美元）根据收入支付医疗费用。Spearman检验评估实体瘤患者SES与疾病分期之间的相关性。使用Cox回归模型确定风险比。采用Kaplan-Meier法估计总生存率（OS）。
共有1598名儿童符合分析条件；1269名患有实体瘤，SES与分期呈负相关（Spearman秩相关系数=-0.178；p<0.001）。SES较低的实体瘤患者中III期和IV期疾病的比例相对较高（p<0.01）。随着SES类别的升高，这一比例下降。在对性别、年龄、肿瘤类型和分期进行调整的多变量分析中，较高的SES与较低的死亡风险相关（p<0.001），这表明SES对生存的影响超过了仅由较低分期疾病所解释的任何影响。在所有组和所有SES阶层中，种族与SES之间存在很强的正相关（Fisher精确检验，p<0.001）。H3家庭儿童的五年OS为85.3%，而H0家庭儿童为46.3%（p<0.001）。
在南非，SES对实体瘤儿童的癌症生存有显著影响。在南非，SES是种族的有力替代指标，可作为儿童癌症疾病预后的衡量标准。倡导增加对贫困患者的社会支持对于通过标准化国家治疗指南实现治疗结果的公平改善至关重要。
