Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

Abstract

Purpose: To determine the independent contribution of population socioeconomic and health system factors on childhood cancer survivors' medical care and screening. Methods: 7899 childhood cancer survivors in the United States and Canada enrolled in the Childhood Cancer Survivor Study (CCSS). Population-level factors were derived from U.S. Area Health Resource File or 201 Canadian Census. Health service utilization and individual-level factors were self-reported. Multivariable logistic regression was used to calculate the effect of population factors on medical care (any care vs. no care; risk-based care vs. general care) and indicated echocardiogram or mammogram, adjusting for individual sociodemographic and health status. Results: After adjusting for individual factors, population factors had a nominal impact on childhood cancer survivors' medical care and screening. Higher population median income was associated with risk-based survivor-focused care versus general care (odds ratio [OR] 1.05, 95% confidence interval [CI], 1.01-1.09) among all participants, but not among U.S. residents only (OR 1.03, 95% CI, 0.99-1.07). For U.S. residents, the number of CCSS centers within the geographic area was associated with greater odds of receiving risk-based survivor-focused medical care (OR 1.12, 95% CI, 1.04-1.20). Areas with higher median income had higher rates of echocardiogram screening among survivors at risk of cardiomyopathy (for every $10,000 increase in median income, there is a 12% increase in odds of echocardiogram screening; 95% CI 1.05-1.20). A positive relationship was identified between greater number of physicians and surgeons in the county of residence and recommended echocardiogram (for every additional 1000 physicians and surgeons: OR 1.12, 95% CI, 1.01-1.23). We found no association between population-level factors and mammography screening. Conclusions: Population socioeconomic disparities moderately affect childhood cancer survivors' risk-based medical care and screening after accounting for individual sociodemographic and health factors.

Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors

“…42 Moreover, Caplin et al found that areas with higher SES had higher rates of echocardiogram screening for CVD among childhood cancer survivors (OR: 1.12, 95% CI: 1.05-1.20). 43 We observed no racial disparities in risk of CVD mortality among survivors of childhood and AYA leukemias. Prior investigations into racial differences, and late cardiovascular effects, have been primarily studied in the childhood leukemia population.…”

Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors

“…While the uninsured CCS and those on Medicaid may be able to obtain primary care through safety net providers such as public hospitals and/or federally qualified health centers, these providers are often overcrowded with demand typically beyond their capacity in many communities. 27,28 Finally, it is noteworthy that 1 in 5 CCS lack access to a regular provider for both forms of care, suggesting that the health care system is largely out of reach for many survivors as they get older and transition from pediatric to adult care.…”

Key Determinants for Achieving Enteral Autonomy and Reduced Parenteral Nutrition Exposure in Pediatric Intestinal Failure

“…Geographic and racial disparities have been shown to influence outcomes in various diseases in both children and adults . Furthermore, in another manuscript produced by PIFCon, race did correlate with certain outcomes in pediatric IF, namely death and transplantation .…”