Socioeconomic characteristics and relapse-free and overall survival from childhood cancer – a nationwide study based on data from the Danish Childhood Cancer Registry

Authors

  • Fie Stegenborg Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark https://orcid.org/0009-0006-9591-4500
  • Mathilde S. Bek Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
  • Charlotte J. Nilsson Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  • Line H. Pedersen Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
  • Thomas Scheike Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  • Lisa L. Hjalgrim Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet
  • Friederike Erdmann Research group Etiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
  • Kjeld Schmiegelow Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
  • Pernille Bidstrup Psychological Aspects of Cancer, Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Denmark
  • Line Kenborg Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
  • Jeanette F. Winther Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Denmark
  • Hanne B. Larsen Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet
  • Susanne O. Dalton Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark; Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark

DOI:

https://doi.org/10.2340/1651-226X.2025.42131

Keywords:

Childhood cancer, Socioeconomic position, Social inequality, relapse, Cancer survival, register-based study, Socioeconomic status

Abstract

Background and purpose: Over the past decades, childhood cancer survival has increased substantially in Europe, including Denmark. However, families with fewer social resources may have benefitted less from these improvements. In this nationwide register-based study, we assessed associations between parental socioeconomic position (SEP) and 5-year relapse-free survival (RFS) and overall survival (OS) in childhood cancer patients.

Material and methods: All children aged <16 years diagnosed with cancer in Denmark between 1998 and 2017 were identified in the Danish Childhood Cancer Registry (N = 3245). Parents, with whom the children resided, were identified, and data on the parents’ education, cohabitation status, affiliation to work market, country of origin, and vital status of the children were obtained through individual-level linkage across Danish nationwide registries. Cox proportional hazards models were used to estimate the association between SEP indicators and 5-year RFS and OS.

Results and interpretation: Tendencies towards lower 5-year RFS and OS were observed among children whose parents were unemployed/not in workforce (RFS: HR [hazard ratio] = 1.14, 95% CI [confidence interval]: 0.90–1.45, OS: HR = 1.28, 95% CI: 0.95–1.71) or from non-Western countries (RFS: HR = 1.21 95% CI: 0.96–1.52, OS: HR = 1.44, 95% CI: 1.09–1.90). Results by diagnostic groups revealed particularly low OS for children with non-central nervous system tumors whose parents were from non-Western countries (HR = 1.92, 95% CI: 1.24–2.97). Targeted strategies are needed to promote social equity and ensure optimal diagnosis, care, and management of childhood cancer across social groups.

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Author Biography

Friederike Erdmann, Research group Etiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany

Research group Etiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Germany

Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany

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Published

2025-01-29

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Stegenborg, F., Bek, M., Nilsson, C., Pedersen, L. H., Scheike, T., Hjalgrim, L., … Dalton, S. (2025). Socioeconomic characteristics and relapse-free and overall survival from childhood cancer – a nationwide study based on data from the Danish Childhood Cancer Registry. Acta Oncologica, 64, 179–187. https://doi.org/10.2340/1651-226X.2025.42131

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Vol. 64 (2025): Acta Oncologica

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Copyright (c) 2025 Fie Stegenborg, Mathilde S. Bek, Charlotte J. Nilsson, Line H. Pedersen, Thomas Scheike, Lisa L. Hjalgrim, Friederike Erdmann, Kjeld Schmiegelow, Pernille Bidstrup, Line Kenborg, Jeanette F. Winther, Hanne B. Larsen, Susanne O. Dalton

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