Stegenborg Fie, Bek Mathilde, Nilsson Charlotte, Pedersen Line H, Scheike Thomas, Hjalgrim Lisa, Erdmann Friederike, Schmiegelow Kjeld, Bidstrup Pernille, Kenborg Line, Winther Jeanette, Larsen Hanne, Dalton Susanne
Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark.
Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Acta Oncol. 2025 Jan 29;64:179-187. doi: 10.2340/1651-226X.2025.42131.
Over the past decades, childhood cancer survival has increased substantially in Europe, including Denmark. However, families with fewer social resources may have benefitted less from these improvements. In this nationwide register-based study, we assessed associations between parental socioeconomic position (SEP) and 5-year relapse-free survival (RFS) and overall survival (OS) in childhood cancer patients.
All children aged <16 years diagnosed with cancer in Denmark between 1998 and 2017 were identified in the Danish Childhood Cancer Registry (N = 3245). Parents, with whom the children resided, were identified, and data on the parents' education, cohabitation status, affiliation to work market, country of origin, and vital status of the children were obtained through individual-level linkage across Danish nationwide registries. Cox proportional hazards models were used to estimate the association between SEP indicators and 5-year RFS and OS.
Tendencies towards lower 5-year RFS and OS were observed among children whose parents were unemployed/not in workforce (RFS: HR [hazard ratio] = 1.14, 95% CI [confidence interval]: 0.90-1.45, OS: HR = 1.28, 95% CI: 0.95-1.71) or from non-Western countries (RFS: HR = 1.21 95% CI: 0.96-1.52, OS: HR = 1.44, 95% CI: 1.09-1.90). Results by diagnostic groups revealed particularly low OS for children with non-central nervous system tumors whose parents were from non-Western countries (HR = 1.92, 95% CI: 1.24-2.97). Targeted strategies are needed to promote social equity and ensure optimal diagnosis, care, and management of childhood cancer across social groups.
在过去几十年中，欧洲（包括丹麦）儿童癌症的生存率大幅提高。然而，社会资源较少的家庭可能从这些改善中获益较少。在这项基于全国登记数据的研究中，我们评估了儿童癌症患者父母的社会经济地位（SEP）与5年无复发生存率（RFS）和总生存率（OS）之间的关联。
在丹麦儿童癌症登记处确定了1998年至2017年间在丹麦诊断为癌症的所有16岁以下儿童（N = 3245）。确定了与孩子居住在一起的父母，并通过丹麦全国登记处之间的个人层面链接，获取了有关父母教育程度、同居状况、劳动力市场归属、原籍国以及孩子生命状况的数据。使用Cox比例风险模型来估计SEP指标与5年RFS和OS之间的关联。
在父母失业/未就业的儿童（RFS：风险比[HR]=1.14，95%置信区间[CI]：0.90-1.45，OS：HR = 1.28，95% CI：0.95-1.71）或来自非西方国家的儿童（RFS：HR = 1.21，95% CI：0.96-1.52，OS：HR = 1.44，95% CI：1.09-1.90）中，观察到5年RFS和OS有降低的趋势。按诊断组划分的结果显示，父母来自非西方国家的非中枢神经系统肿瘤儿童的OS特别低（HR = 1.92，95% CI：1.24-2.97）。需要有针对性的策略来促进社会公平，并确保不同社会群体的儿童癌症得到最佳诊断、护理和管理。
