title: Socioeconomic disparities in childhood cancer survival in Switzerland.
abstract: In this study, we investigated whether childhood cancer survival in Switzerland is influenced by socioeconomic status (SES), and if disparities vary by type of cancer and definition of SES (parental education, living condition, area-based SES). Using Cox proportional hazards models, we analyzed 5-year cumulative mortality in all patients registered in the Swiss Childhood Cancer Registry diagnosed 1991-2006 below 16 years. Information on SES was extracted from the Swiss census by probabilistic record linkage. The study included 1602 children (33% with leukemia, 20% with lymphoma, 22% with central nervous system (CNS) tumors); with an overall 5-year survival of 77% (95%CI 75-79%). Higher SES, particularly parents' education, was associated with a lower 5-year cumulative mortality. Results varied by type of cancer with no association for leukemia and particularly strong effects for CNS tumor patients, where mortality hazard ratios for the different SES indicators, comparing the highest with the lowest group, ranged from 0.48 (95%CI: 0.28-0.81) to 0.71 (95%CI: 0.44-1.15). We conclude that even in Switzerland with a high quality health care system and mandatory health insurance, socioeconomic differences in childhood cancer survival persist. Factors causing these survival differences have to be further explored, to facilitate universal access to optimal treatment and finally eliminate social inequalities in childhood cancer survival.
authors: Swiss Tropical and Public Health Institute, 4002, Basel, Switzerland.|University of Basel, 4001, Basel, Switzerland.|Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland.
authors: Martin
authors: M
authors: Adam
authors: Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland.|Department of Health Sciences and Health Policy, University of Lucerne, 6002, Lucerne, Switzerland.
authors: Corina S
authors: CS
authors: Rueegg
authors: Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland.
authors: Kurt
authors: K
authors: Schmidlin
authors: Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland.
authors: Adrian
authors: A
authors: Spoerri
authors: Pediatric Hematology-Oncology Unit, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland.
authors: Felix
authors: F
authors: Niggli
authors: Pediatric Hematology-Oncology Unit, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland.
authors: Michael
authors: M
authors: Grotzer
authors: Pediatric Hematology-Oncology Unit, University Children's Hospital Basel, University of Basel, 4056, Basel, Switzerland.
authors: Nicolas X
authors: NX
authors: von der Weid
authors: Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland.
authors: Matthias
authors: M
authors: Egger
authors: Swiss Tropical and Public Health Institute, 4002, Basel, Switzerland.|University of Basel, 4001, Basel, Switzerland.
authors: Nicole
authors: N
authors: Probst-Hensch
authors: Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland.
authors: Marcel
authors: M
authors: Zwahlen
authors: Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland.
authors: Claudia E
authors: CE
authors: Kuehni
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors; D013557:Switzerland / Q000453:epidemiology
keywords: 5-year survival; central nervous system tumor; childhood cancer; leukemia; mortality; socioeconomic status