Socioeconomic Status and Childhood Cancer Incidence: A Population-Based Multilevel Analysis
Menée aux Etats-Unis à partir de données portant sur 2 947 patients atteints de cancer et âgés de moins de 14 ans et sur 11 907 témoins, cette étude évalue l'association entre le statut socio-économique de la mère et de l'entourage et le risque de développer la maladie pendant l'enfance
The etiology of childhood cancers remains largely unknown, especially regarding environmental and behavioral risk factors. Unpacking the association between socioeconomic status (SES) and incidence may offer insight into such etiology. We tested associations between SES and childhood cancer incidence in a population-based case-cohort study (source cohort: Minnesota birth registry, 1989–2014). Cases, 0–14 years, were linked from the Minnesota Cancer Surveillance System to birth records through probabilistic record linkage. Controls were 4:1 frequency matched on birth year (2,947 cases, 11,907 controls). We tested associations of individual-level (maternal education) and neighborhood-level (census tract composite index) SES using logistic mixed models. In unadjusted models, maternal education was positively associated with incidence of acute lymphoblastic leukemia (odds ratio (OR) = 1.10; 95% confidence interval (CI): 1.02, 1.19), central nervous system tumors (OR = 1.12; 95% CI: 1.04, 1.21), and neuroblastoma (OR = 1.15; 95% CI: 1.02, 1.30). Adjustment for established risk factors, including race/ethnicity, maternal age, and birthweight, substantially attenuated these positive associations. Similar patterns were observed for neighborhood-level SES. Conversely, higher maternal education was inversely associated with hepatoblastoma incidence (adjusted OR = 0.70; 95% CI: 0.51, 0.98). Overall, beyond the social patterning of established demographic and pregnancy-related exposures, SES is not strongly associated with childhood cancer incidence.