Survival from tumours of the central nervous system in Danish children: Is survival related to family circumstances?

Abstract

Little is known about social inequalities in childhood cancer survival. We investigated the impact of family circumstances on survival from paediatric central nervous system (CNS) tumours in a nationwide, register-based cohort of Danish children.

All children born between 1973 and 2006 and diagnosed with a CNS tumour before the age of 20 years (N=1,261) were followed until 10 years from diagnosis. Using Cox proportional hazards models, the impact of various family characteristics on overall survival was estimated.

Hazard ratios (HR) for all CNS tumours combined did not show strong associations between survival and any family characteristic. Analyses by CNS tumour subtypes showed reduced survival for children with glioma when living outside of Copenhagen (HR 1.55; CI 1.03; 2.35). For embryonal CNS tumours, the number of full siblings was associated with worse survival (HR for having 3+ siblings 3.60; CI 1.52; 8.53) and a trend of better survival was observed for children with parents of younger age at child's diagnosis and poorer survival of children with parents of older age.

Despite free and uniform access to health care services, some family circumstances appear to affect survival from specific CNS tumour types in Danish children. Further research is warranted to gain a more comprehensive understanding of the impact of family factors on childhood cancer survival in other populations and to elaborate underlying mechanisms and pathways of those survival inequalities observed.

While access to uniform health care and standardized treatments is free in Denmark, Danish children with cancer may not benefit equally from the health system. Whether social inequalities account for these differences is uncertain. Here, associations between family circumstances and survival of pediatric tumors of the central nervous system were analyzed for a cohort of Danish children born between 1973 and 2006. The findings show that certain family circumstances, including number of siblings, place of residence, and parent age at time of diagnosis, are associated with survival. Targeted interventions may be needed to further improve survival rates and reduce inequities. This article is protected by copyright. All rights reserved.

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