African American children with lymphoma had a survival disadvantage and excess mortality relative to their White counterparts, a new study showed. This difference may be driven by social determinants of health (SDH).
“The observed variance is suggestive of the need to consider SDH driven by social injustice and inequity in addressing pediatric lymphoma mortality in the US,” study authors wrote.
The study included 10,201 children aged 0 to 19 years who were diagnosed with lymphoma. The researchers assessed cumulative incidence, mortality, and survival with data from the Surveillance, Epidemiology, and End Results Program.
The cumulative incidence of lymphoma was higher among White children (76.67%) compared to African American children (13.44%), American Indian/Alaskan Native children (0.67%), and Asian/Pacific Islanders (7.53%).
However, African American children had excess mortality compared with White children (risk ratio [RR]=1.54; 95% confidence interval [CI]=1.33-1.79). African Americans were 52% more likely to die (hazard ratio [HR]=1.52; 95% CI, 1.30-1.78) compared with White counterparts.
“Survival varied by urbanity, implying the survival disadvantage of children with lymphoma residing in the rural area,” the researchers wrote.
Relative to children that lived in metropolitan areas, children in rural areas were 29% more likely to die (HR=1.29; 95% CI, 1.07-1.56). Survival was also influenced by household median income, with worse survival in lower income quintiles.
Even after adjustment for tumor prognostic factors, household median income, and urbanity, African American patients still had a survival disadvantage.
“The observed excess mortality among Black children is explained in part by the SDH, which reflects social injustice in the allocation of resources that support human health, as well as social gradient,” the researchers wrote.