Abstract B081: Age-stratified associations between social and geospatial factors and childhood and adolescent cancer survival: An analysis of 2000-2021 SEER data

Abstract

Cancer is the number one cause of death by disease among children in the United States. While survival rates have improved dramatically over time, differences in cancer outcomes persist by a number of different factors, including social drivers of health. Further, adolescents and young adults have not experienced the same survival gains as younger children. The objective of this study was to identify age-related differences in disparities in pediatric and adolescent cancer outcomes. This population-based longitudinal study uses data from SEER 17, Specialized Incidence Data with County Codes from 2000 to 2021. Couty-level childhood food insecurity rates were obtained from Feeding America’s Map the Meal Gap data. County-level rurality was assessed with Rural Urban Continuum Codes. Cox proportional hazards models were used to compute adjusted hazard ratios (aHRs) for the association between food insecurity, rurality, race/ethnicity and pediatric cancer survival stratified by age (children (0-14) and adolescents (15-19)). A directed acyclic graph was used to identify variables needed to adjust for to control for confounding. A total of 85,768 children and adolescents with cancer were included in this study, with 26.5% residing in a high food insecurity county (food insecurity rate over 25%) at the time of diagnosis. Adolescents residing in high food insecurity counties had a higher hazard of cancer mortality (aHR=1.09, 95% CI: 1.01-1.17), while there was no association between food insecurity and mortality among younger children. Similarly, adolescents residing in rural counties had a higher hazard of cancer mortality than those living in urban counties (aHR=1.12, 95% CI: 1.00-1.26), while there was no association among younger children. Racial/ethnic disparities were also greater among adolescents compared to younger children. Compared to Non-Hispanic White adolescents, Black (aHR=1.96, 95% CI: 1.78-2.15) and Hispanic (aHR=1.55, 95% CI: 1.44-1.67) adolescents had a higher hazard of cancer death. Compared to Non-Hispanic White children, Black (aHR=1.57, 95% CI: 1.47-1.68) and Hispanic (aHR=1.37, 95% CI: 1.30-1.44) children had a higher hazard of cancer death, although these effect sizes are smaller than those observed among adolescents. Race/ethnicity and county-level food insecurity and rurality were more strongly associated with cancer mortality among adolescents than younger children in the United States. Further research is needed to understand mechanisms driving disparities in childhood and adolescent cancer outcomes and potential individual- and health systems-level reasons for greater disparities among adolescents. Emma Hymel, Josiane Kabayundo, Krishtee Napit, Amelia Nichols, Shinobu Watanabe-Galloway. Age-stratified associations between social and geospatial factors and childhood and adolescent cancer survival: An analysis of 2000-2021 SEER data [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr B081.