title: The association between socioeconomic status and survival among children with Hodgkin and non-Hodgkin lymphomas in a universal health care system.
abstract: BACKGROUND
  The association between socioeconomic status (SES) and cancer survival has been studied extensively in adults. However, little is known about this relationship in the pediatric population, specifically in jurisdictions with universal health care insurance programs. Our aim was to determine whether lower SES is associated with poorer survival in pediatric Hodgkin (HL) and non-Hodgkin lymphoma (NHL) patients in Ontario.
  
  
  METHODS
  All incident cases of HL and NHL in children between 0 and 14 years old diagnosed in Ontario between January 1st, 1985 and December 31st, 2006 were identified through the Pediatric Oncology Group of Ontario Networked Information System. Neighborhood income quintile and material deprivation quintile at diagnosis were used as proxies for SES. Cox proportional hazards regressions were used to assess the association between SES and the risk of event-free or overall survival.
  
  
  RESULTS
  A total of 692 patients were included in the analysis: 302 HL and 390 NHL. SES was not associated with survival (overall or event-free) among HL and NHL patients (P > 0.05 for all four comparisons, i.e., HL/NHL, EFS/OS) after adjustment for age, sex, period of diagnosis, and disease stage. There were no differences in the distribution of disease stage across SES strata at the time of diagnosis. Similarly, the distribution of deaths among long-term survivors (survived ≥5 years from diagnosis) did not differ across SES strata (P > 0.05).
  
  
  CONCLUSIONS
  SES was not associated with risk of death among pediatric HL and NHL patients in Ontario. This was consistent through the cancer trajectory, including diagnosis, treatment, and survivorship.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Darmawikarta
authors.forename: Jason D
authors.initials: JD
authors.lastname: Pole
authors.forename: Sumit
authors.initials: S
authors.lastname: Gupta
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality*; D008297:Male; D009864:Ontario / Q000453:epidemiology; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors; D019472:Universal Health Insurance