title: Survival from childhood acute lymphoblastic leukaemia in West Germany: does socio-demographic background matter?
abstract: BACKGROUND
  Sex, age, immunophenotype and white blood cell count at diagnosis are well accepted predictors of survival from acute lymphoblastic leukaemia (ALL) in children. Less is known about the relationship between socio-economic determinants and survival from paediatric ALL, studied here for the first time in German children.
  
  
  METHODS
  ALL cases were diagnosed between 1992 and 1994 and their parents interviewed during a previous nationwide case-control study. Children were followed-up for 10 years after diagnosis by the German Childhood Cancer Registry. Cox proportional hazards models estimating hazard ratios (HRs) were calculated to assess the impact of selected socio-demographic characteristics on overall and event-free survival.
  
  
  RESULTS
  Overall survival was 82.5%, with a higher proportion of girls than boys surviving (85% versus 81%). We found a non-linear relationship between age at diagnosis and survival, with poorer survival in infants and children aged >5 years. There was no association between socio-economic factors and survival or risk of relapse. For five levels of increasing family income, all HRs were close to one. No relationship was seen with parental educational level.
  
  
  CONCLUSIONS
  Socio-economic determinants did not affect ALL survival in West German children, in contrast to studies from some other countries. Dissimilarities in social welfare systems, including access to health care, lifestyle and differences in treatment may contribute to these differences in findings. Our observation of no social inequalities in paediatric ALL survival is reassuring, but needs continued monitoring to assess the potential impact of evolvement of treatment options and changes in paediatric health service.
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France. Electronic address: ErdmannF@students.iarc.fr.
authors.forename: Friederike
authors.initials: F
authors.lastname: Erdmann
authors.affiliation: German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Strasse 69, 55101 Mainz, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kaatsch
authors.affiliation: Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstraße 30, 28359 Bremen, Germany.
authors.forename: Hajo
authors.initials: H
authors.lastname: Zeeb
authors.affiliation: Department of Health Sciences, Epidemiology & Cancer Statistics Group, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK.
authors.forename: Eve
authors.initials: E
authors.lastname: Roman
authors.affiliation: Department of Health Sciences, Epidemiology & Cancer Statistics Group, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK.
authors.forename: Tracy
authors.initials: T
authors.lastname: Lightfoot
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schüz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005860:Germany, West / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis
keywords: Demographic factors; Paediatric acute lymphoblastic leukaemia; Socio-economic status; Survival