ORCID ID
Graduation Date
Spring 5-9-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Programs
Epidemiology
First Advisor
Shinobu Watanabe-Galloway
Second Advisor
Jenna Allison
Third Advisor
Edward S. Peters
Fourth Advisor
Kendra Ratnapradipa; Cheng Zheng
Abstract
Pediatric cancer, while relatively rare, is the number one cause of death by disease in children in the US. Five-year relative survival for pediatric cancers has improved overall to over 80%, but the same gains have not been observed among all populations, with noted disparities by race, ethnicity, and socioeconomic status. This dissertation uses data from the Louisiana Tumor Registry and Iowa Cancer Registry in a population-based longitudinal analysis of all children aged 0-19 at diagnosis from 2000 to 2020 in the two states and evaluated the association between neighborhood deprivation, health insurance at diagnosis, and travel burden and pediatric cancer mortality.
We observed that higher levels of neighborhood deprivation, as measured by the Area Deprivation Index (ADI), was associated with a 50% higher hazard of cancer mortality overall, and a 3.15 times higher hazard of cancer early mortality. Compared to children with private health insurance, those with public insurance and no insurance were more likely to die from their cancer. In a causal mediation analysis, we observed that individual-level health insurance was a mediator of the association between ADI and cancer mortality, but it only accounted for 7-14% of the neighborhood-level disparities, indicating that other mechanisms are largely responsible for neighborhood deprivation-based disparities in pediatric cancer outcomes. In addition to these factors, we observed a high travel burden among cancer patients in the study, with over 31% of Iowa children with cancer and over 19% of Louisiana children with cancer traveling over 75 miles to treatment. Travel burden was also associated with cancer mortality; children experiencing high travel burden had a 41% higher hazard of cancer death compared to children experiencing low travel burden.
These findings emphasize that a number of multilevel factors, including neighborhood deprivation, health insurance, and travel burden, are associated with pediatric cancer mortality. To improve pediatric cancer outcomes, multilevel interventions will likely be needed, impacting individual-, institutional-, and policy-level factors.
Rights
The author holds the copyright to this work and any reuse or permissions must be obtained from the author directly.
Recommended Citation
Hymel, Emma, "Impact of Social and Geospatial Factors on Pediatric Cancer Survival: An Analysis of State Cancer Registry Data" (2026). Theses & Dissertations. 1047.
https://digitalcommons.unmc.edu/etd/1047