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Researchers are trying to understand why black and Latino children are more likely to die of certain cancers. FS Productions/Blend Images/Getty Images

When it comes to cancer survival, the United States is sharply divided by race.

According to the Centers for Disease Control and Prevention, the cancer death rate for

African-Americans is 25 percent higher than whites, and Hispanics and Latinos are

more likely to be diagnosed with cancer at a late, and more dangerous, stage of the

disease.

Kids aren't exempt from those disparities either — black and Hispanic children are

more likely to die of many childhood cancers than their white counterparts. So what

explains the survival gap?

For epidemiologist Rebecca Kehm, the answer could lie not in a test tube or even a

patient's race, but in their place in society. In a paper published Monday in the journal

Cancer, Kehm and her coauthors pinpoint socioeconomic status as a factor in

childhood cancer survival.

Scientists have long looked for a biological basis for the different survival rates among

races. Kehm knew that socioeconomic status — a measure of an individual's social

standing, including income, education, and occupation — affects adults' chances of

surviving cancer. Persistent racism and institutional bias means that black and non-

white Hispanic people are much more likely to live in areas of concentrated poverty.

Could this explain why their children are more likely to die of some cancers, too?

"We know that there are socioeconomic differences that are closely tied to race

ethnicity," says Kehm. "I wanted to show that there are other factors at play than the

genetic component."

Kehm and researchers at the University of Minnesota looked at data on nearly 32,000

childhood cancer patients from the National Institutes of Health's Surveillance,

Epidemiology, and End Results Program (SEER), a database of cancer statistics

compiled from 19 geographic areas throughout the United States. Each SEER entry

offers a statistical snapshot of an individual patient, including their race and where

they live. The patients were diagnosed between 2000 and 2012.

The researchers determined the poverty level in the cancer patients' neighborhoods,

using census tract data. Then, they ran a statistical analysis to determine how much

living in a high-poverty neighborhood affected the children's chance of surviving

cancer.

First off, the study confirmed what researchers already know: Race does affect a child's

likelihood of surviving cancer. Black children were between 38 and 95 percent more

likely to die of the nine cancers studied, and Hispanic children were between 31 and 65

percent more likely to die.

Might poverty account for those stark disparities? In nearly half of the types of cancer

cases analyzed, the answer was yes. Socioeconomic status seemed to explain those

racial differences for several cancers, including acute lymphoblastic leukemia, acute

myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma.

For example, a black child who gets acute lymphoblastic leukemia is 43 percent more

likely to die than a white child with the same cancer. With economic status taken into

account, the child would be only 17 percent more likely to die. Overall, socioeconomic

status explained 44 percent of the disparity between black and white children. It also

explained disparities for Hispanic children.

For Karen Winkfield, a radiation oncologist and director of Wake Forest Baptist

Health's Office of Cancer Health Equity in Winston-Salem, N.C., the results aren't

surprising — and that's part of their value.

"People in health equity intuitively know that socioeconomic status is a driver," she

says. "But in the scientific world, the medical world, the only way that people believe it

is if they see it in writing."

Studies like this one, she says, put focus on those who can't speak for themselves.

"There are children who die who should not die because their parents are poor," she

says. "What does this say about our society?"

In one of the cancers, acute myeloid leukemia, socioeconomic status acted very

differently on disparities for Hispanic and black children, who have a similar survival

rate compared to white children. It explained 73 percent of the survival difference

between Hispanic and white kids, but it only explained 28 percent of the survival

difference between black and white children. That could mean that other factors, like

availability of bone marrow donor matches, some difference in tumor biology, or other

social factors, increase black children's risks.

The study had its limitations: It looked at neighborhood level, not individual,

measures of social class. The analysis also didn't dive into how much or what kind of

health insurance patients had or how well educated their parents were. "We likely

didn't capture all of the factors that contribute to one's social and economic standing,"

says Kehm.

And social class didn't explain all of the disparities: For instance, for central nervous

system tumors and soft tissue sarcomas, socioeconomic status didn't move the needle

on the racial differences.

Knowing that kids living in poverty have greater cancer risk, researchers can delve into

exactly how poverty affects children's health. People with a lower socioeconomic status

are exposed to more carcinogens than more affluent people. And kids may face

challenges getting screenings or treatments, for example, if their parents have trouble

affording transportation or taking time off of work.

Winkfield sees the study as a springboard for a larger conversation about how

resources can be better allocated to serve children — and adults — whose

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socioeconomic status limits their likelihood to survive cancer.

Kehm, who conducted the research as part of her Ph.D. program and is now a postdoc

at Columbia University, agrees.

"It's not enough to simply do studies," she says. "We need to figure out specific things

we can do to address these disparities. There are things we can do now that don't

require money to pour into pharmaceutical development — things that are

manageable and can actually make a difference now, today."

Erin Blakemore is a science writer based in Boulder, Colo.

african american health latino health racial disparities childhood cancer

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