Territorial Socioeconomic Vulnerability and Clinical Outcomes in Pediatric Cancer at a Colombian Referral Center

Background/Objectives: Childhood cancer outcomes are influenced by clinical, socioeconomic, and territorial factors, particularly in resource-limited settings. This study characterized pediatric cancer patients from Córdoba and Sucre, Colombia, and evaluated factors associated with clinical outcomes in a regional referral center. Methods: A retrospective hospital-based study included 434 patients aged 0–18 years diagnosed between 2018 and 2024. Sociodemographic, clinical, and territorial socioeconomic variables were analyzed using the Multidimensional Poverty Index (MPI). Clinical outcomes were classified as favorable, non-favorable, or death. Firth-penalized logistic regression models were used to assess adjusted associations. Results: Hematologic malignancies predominated (65.9%), with acute lymphoblastic leukemia as the most frequent diagnosis. Most patients came from municipalities with moderate or high multidimensional poverty (85.2%), and the rural territories of origin showed greater deprivation in education, employment, housing, water access, and sanitation. Favorable outcomes occurred in 82.9% of patients, while 8.5% had non-favorable outcomes and 8.5% died. Older age and non-hematologic malignancies were associated with non-favorable outcomes. Mortality was associated with older age, subsidized health insurance, and non-hematologic malignancies. MPI and rural residence were not independently associated with outcomes after adjustment. Conclusions: Although MPI was not independently associated with clinical outcomes, it identified substantial territorial deprivation. Integrating clinical and territorial indicators may support equity-oriented surveillance and pediatric oncology interventions.