Factors associated with early death among children and adolescents with cancer in Brazil: a nationwide registry-based study

This study aimed to identify sociodemographic, clinical, and care-related factors associated with early death in childhood and adolescent cancer patients in Brazil. A retrospective cohort study was conducted using data from the Brazilian Hospital Cancer Registry Integrator Database (IntegradorRHC). All cancer cases diagnosed in individuals aged 0-19 years between 2000 and 2023 were included. Early death was defined as death at the end of the first treatment or within 12 months after diagnosis. Associations were assessed using multivariable logistic regression, and results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Among 102,430 eligible cases, early death occurred in 24.7%. Increased risk of early death was independently associated with older age at diagnosis (aOR = 1.006), non-white race/skin color (aOR = 1.467), missing information on race/skin color (aOR = 3.177), unknown referral origin (aOR = 3.507), residence in the Southeast region (aOR = 1.921), and receipt of chemotherapy (aOR = 1.624). Central nervous system tumors (aOR = 2.430), soft tissue sarcomas, bone tumors, and leukemias showed the highest risk of early death. Surgery (aOR = 0.636) and radiotherapy (aOR = 0.750) were associated with reduced risk, while lymphomas (aOR =0.70) showed a protective association. Early death among pediatric cancer patients in Brazil is strongly influenced by tumor type and marked social, regional, and informational disparities.