Document Type

Article

Journal Title

Cancer Medicine

Publication Date

2026

Volume

15

Abstract

BACKGROUND: Socioeconomic (SE) factors have been shown to mediate racial and ethnic disparities in adult cancer mortality. However, evidence in pediatric cancer is limited, especially at finer geographic levels.

OBJECTIVE: Evaluate the mediating effect of socioeconomic status (SES) and persistent poverty in racial and ethnic disparities in childhood cancer mortality using census tract-level data.

METHODS: Data were obtained from the 2006-2020 SEER Incidence Data with Census Tract Attributes Database and included children 0-19 years. Neighborhood-level SES was measured using a composite variable with five categories. Census tracts were classified as persistently poor if 20% or more of the population lived below the poverty level for 30 years. Cause-specific Cox proportional-hazard models were used to examine the association of race and ethnicity with cancer mortality, adjusting for age, gender, stage at diagnosis, cancer type, and rurality. A weighted approach mediation analysis was performed in R4.1.3.

RESULTS: Among 96,665 included cases, 19.95% of children lived in the lowest SES quintile, and 12.23% lived in areas with persistent poverty. The distribution of SES and persistent poverty varied across race and ethnicity. Specifically, 9.79% of White children lived in the lowest SES neighborhoods compared to 33.77% of Black and 32.48% of Hispanic children. In addition, 4.83% of White children lived in persistent poverty compared to 21.38% of Black and 21.30% of Hispanic children. Compared to White children, the risk of cancer death was higher among Black (aHR: 1.53; 95% CI: 1.45-1.62), Hispanic (aHR: 1.17; 95% CI: 1.12-1.22), and Asian (aHR: 1.24; 95% 1.15-1.33) children. The proportion mediated by SES was 13.50% for Black, 29.3% for Hispanic, and 37.58% among AI/AN children. The proportion mediated by persistent poverty was 6% for Black, 12.79% for Hispanic, and 17.47% for AI/AN children.

CONCLUSION: SES and persistent poverty significantly contributed to racial and ethnic differences in pediatric cancer mortality.

MeSH Headings

Humans, Neoplasms, Child, Female, Male, Adolescent, Child, Preschool, United States, Infant, Poverty, Social Class, SEER Program, Infant, Newborn, Health Status Disparities, Ethnicity, Young Adult, Racial Groups

ISSN

2045-7634

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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