Ongoing research efforts have improved the treatment and outcomes of most pediatric cancers.1 However, non–treatment-related factors have been associated with pediatric mortality, including parent-associated factors such as socioeconomic status.

Parent Education Level

An observational, case-cohort study sought to determine if parental education level was the reason that socioeconomic status is associated with shorter mortality among pediatric patients with cancer.2 The study followed 1889 children with cancer and 108,387 children without cancer for 6 years and found that low level of parental education was significantly associated with a 20% greater risk for mortality among  children with cancer compared with a high education level (mortality risk ratio [MRR], 0.80; 95% CI, 0.70-0.91). An intermediate education level demonstrated a more modest association (MRR, 0.90; 95% CI, 0.81-1.00). This risk was maintained when the data were adjusted for country of origin, geographic area of residence, employment status, and number of siblings. When looked at individually, only mortality from leukemia was associated with parental education level, whereas cancers of the bone, connective or soft tissue, central nervous system, and lymphomas were not associated with education level.

The results from this study were consistent with results from another study, in which 4437 pediatric patients with cancer were followed for 5 years.3 A high level of parental education, which was defined as post–secondary education, was significantly associated with lower mortality compared with a lower level of education, defined as primary school or secondary school, for pediatric patients diagnosed between 2000 and 2009 (hazard ratio [HR], 0.66; 95% CI, 0.54-0.81).

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This study also looked at income level and found that the highest level of disposable income was also significantly associated with lower mortality, with survival of 86% compared with the lowest level of disposable income with survival at 79% (HR, 0.68; 95% CI, 0.52-0.89). These findings are interesting because the study was conducted in Finland, which guarantees access to health care through universal health care coverage. However, the authors note that individuals can seek medical care privately.

These studies suggest that mortality rates associated with pediatric cancer may be influenced by parental factors, particularly socioeconomic status. Although the reason behind this is multifactorial, access to care is likely a major driver for the difference in mortality rates.