Socioeconomic background and childhood cancer survival in Germany : a nationwide assessment based on data from the German Childhood Cancer Registry

Abstract

Social inequalities in childhood cancer survival have been observed in many countries, including European nations with universal healthcare systems, suggesting that not all children with cancer have benefited equally from diagnostic and therapeutic enhancements. Despite the growing socioeconomic diversity within Germany's large population, little is known about the extent of social inequalities in German childhood cancer survival. Using German Childhood Cancer Registry data, we identified all children with a cancer diagnosis before the age of 15 years in 1997–2016 in Germany (N = 35,443). Based on individual residential address information (at time of diagnosis) we applied the German Index of Socioeconomic Deprivation (GISD) to measure area-based socioeconomic status. Using Cox proportional hazards models, we assessed the association between absolute area-based socioeconomic deprivation (AASD) and 10-year overall survival (OS) (end of follow-up: 15 January 2023) to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI). The multivariable analyses revealed a null association for AASD and 10-year OS for all cancers combined (HRadj = 1.00, 95% CI 0.97; 1.03). Among children diagnosed with acute myeloid leukaemia and germ cell tumors, a higher AASD (higher levels of deprivation) appeared to be associated with worse survival, particularly pronounced in boys. The opposite was observed among children diagnosed with central nervous system tumors. Contrary to reports from other European countries, we found little evidence for social inequalities in childhood cancer survival in Germany when analysing the GISD. Further research assessing individual-level measures of socioeconomic status is warranted.

What's New? Significant advances in childhood cancer survival have transformed outcomes for many children globally. However, emerging evidence suggests that, even in settings with universal healthcare, these gains are not equally distributed. Here, the authors focused on childhood cancer survival in Germany, using data from the German Childhood Cancer Registry to identify associations with area-based socioeconomic status (SES) measures that encompass defined geographical regions. Overall, the idea that social inequalities are associated with childhood cancer survival in Germany was largely unsupported. Future investigations are needed to determine whether other SES dimensions, particularly family SES, impact survival patterns among children with cancer.