Abstract PR007: Persistent poverty is associated with risk of early mortality among children with cancer: An analysis of SEER data

Abstract Objectives: Social determinants of health are understudied in the context of pediatric cancer. Persistent poverty, a measure developed by the National Cancer Institute and the US Department of Agriculture’s Economic Research Service, is defined as having 20% or more of an area’s population having lived below the poverty level for a period of about 30 years. The effect of persistent poverty on pediatric cancer outcomes is not well understood. Methods: This population-based longitudinal study uses data from the Surveillance, Epidemiology, and End Results (SEER)-22 registries Incidence Data with Census Tract Attributes Database. All primary cases of malignant cancer diagnosed among children aged 0-19 at diagnosis from 2006-2020 were included. Early mortality was defined as death within three months of diagnosis. Cox proportional hazards models were used to compute crude and adjusted hazard rations (aHRs) for the association between persistent poverty and early mortality. Based on a directed acyclic graph, models were also adjusted for age, sex, race/ethnicity, cancer type, and rurality (defined using Rural Urban Commuting Area codes). Results: The study included 97,132 children; 12.63% resided in a persistent poverty census tract at diagnosis and 1.66% died within three months of diagnosis. In the adjusted model, living in a persistent poverty census tract was associated with a higher risk of early mortality (aHR=1.26, 95% CI: 1.10-1.45). Additionally, a higher risk of early mortality was observed among Non-Hispanic Black (aHR=1.44, 95% CI: 1.23-1.70), Non-Hispanic Asian and Pacific Islander (aHR=1.39, 95% CI: 1.15-1.68), and Hispanic children (aHR=1.33, 95% CI: 1.18-1.49) compared to Non-Hispanic White children. Children residing in rural areas also had a higher risk of death compared to children in urban areas (aHR=1.29, 95% CI: 1.11-1.50). In sensitivity analyses looking at the effect of persistent poverty on risk of death within one month of diagnosis, a similar effect size was observed (aHR=1.26, 95% CI: 1.07-1.48). Conclusions: Our study observed an increased risk of early mortality among children living in persistent poverty census tracts and among racial/ethnic minorities. Future studies should explore potential mediators of the association between persistent poverty and early mortality, including health insurance, treatment access, and individual-level socioeconomic status. Citation Format: Emma Hymel, Josiane Kabayundo, Krishtee Napit, Shinobu Watanabe-Galloway. Persistent poverty is associated with risk of early mortality among children with cancer: An analysis of SEER data [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pediatric Cancer Research; 2024 Sep 5-8; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl):Abstract nr PR007.