Original PaperSurvival from childhood cancer in Yorkshire, U.K.: effect of ethnicity and socio-economic status
Introduction
The prospects of survival for children diagnosed with cancer have improved substantially in recent decades in the U.K., with approximately two-thirds of children surviving for at least 10 years [1]. However, certain types of cancer and specific characteristics of the children such as sex and age, as well as the treatment they receive and where it is delivered, continue to influence outcome and affect survival chances 2, 3
Cancer incidence in U.K. children displays variation by ethnic group with a notable excess of lymphomas in children of Asian ethnic origin 4, 5, 6, 7, but it is not known whether ethnicity influences survival in a U.K. setting. One study in the U.S.A. has shown black and caucasian children with similar 10-year survival rates, whereas historically black children had a significantly poorer rate of survival [8]. Investigations of ethnicity are subject to the potential confounding effects of levels of deprivation. This is illustrated by examination of U.K. 1991 decennial census data for Yorkshire, U.K., which clearly shows a positive association between areas with a high proportion of non-white households and raised levels of deprivation; these mainly occur in highly urbanised environments. This highlights the importance of an approach which examines both ethnicity and deprivation in an effort to disentangle their potentially separate effects.
The U.K. childhood (0–14 years) population comprises 5% of people whose ethnic group is described as south Asian (source: The 1991 Census, Crown Copyright. ESRC purchase) including, in the main, people described as Indian, Pakistani and Bangladeshi, which essentially reflects the geographical boundaries of their country of origin and not necessarily their ethnic group [9]. Within the U.K., south Asians reside principally within a small number of metropolitan urban areas, including West Yorkshire, where in 1991 they comprised 12% of children, the majority of whom will have been born in Britain. There is a particularly high concentration of south Asians in the Bradford district of West Yorkshire, where one-quarter of all children are south Asian. Bradford's Pakistani population, the largest of the south Asian group, became established in the early 1960s and is the largest ethnic community in northern England. The area of Pakistan from which this community migrated is highly localised to the northern Mirpur region [10]. Although some changes will have occurred in the composition and relative proportions of the south Asian populations of Yorkshire over the last three decades, it remains one of the few areas in the U.K. where there is an opportunity to study aspects of health and disease in a south Asian minority ethnic population.
Our study utilised follow-up data from a high-quality population-based incidence register of childhood cancers [11] to examine patterns of survival over a 22-year period. The putative influence of deprivation and whether the children's ethnic group was south Asian are specifically addressed.
Section snippets
Patients and methods
The Yorkshire Children's Tumour Register (YCTR) is a population-based register of childhood malignancies with a high level of completeness, for example between 1974 and 1995 over 80% of central nervous systems (CNS) tumours were histologically verified [11]. Demographic, diagnostic and clinical details are held for children diagnosed with a malignant disease prior to their fifteenth birthday whilst resident within the northern English counties of North Yorkshire, West Yorkshire and Humberside
Results
15 children from the register were lost to follow-up representing 0.8% of all cases (n=1979), although some years of survival may have been contributed prior to their censor dates to the total of 12 742 person-years of survival. Of those lost to follow-up 12 had emigrated, 1 was registered with the Armed Services and 2 were untraceable. The losses to follow-up were proportionate across the diagnostic groups (see Table 1).
Length of follow-up ranged from 0 days to 24 years (median 4 years 1
Discussion
Population-based survival rates for childhood cancer are published less frequently than results of clinical trials but are nonetheless important both from a clinical and public health perspective. This study was undertaken using the YCTR, a specialist register of children with cancer, which is considered to represent the population with respect to completeness and accuracy [11].
The purpose of the study was to investigate a prior the putative effects of ethnicity and deprivation on survival. As
Acknowledgements
This work has been funded by the Candlelighters Trust, St James' Hospital, Leeds, U.K. The careful data collection and processing by Linda Proctor and Helen Lilley has been crucial and Dr Anthony Staines is thanked for his contribution in managing the register. Neuropathologists Dr James Ironside, Dr Sally Lane and Dr Lesley Bridges are thanked for their assistance with histopathological review. Dr Isabel dos Santos Silva of the London School of Tropical Medicine and Hygiene is thanked for the
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2014, The Lancet OncologyCitation Excerpt :However, data for childhood cancer mortality by ethnic origin are scarce and inconsistent.8,13–15 The effect of ethnic origin and socioeconomic status on the survival of children with cancer has been investigated in the UK,16,17 USA,8,18,19 and New Zealand,20 albeit with inconsistent results. Although some studies have been done on the burden of childhood cancer in indigenous children in specific countries, international comparisons have not been reported.
Survival trends of cancer amongst the south Asian and non-south Asian population under 30 years of age in Yorkshire, UK
2012, Cancer EpidemiologyCitation Excerpt :Furthermore, an estimated 60% of the south Asian population within the study region originates from Mirpur in rural Pakistan, making it one of the few regions in the UK that allows for detailed analysis of a relatively homogeneous south Asian population [30]. A few UK studies, including one from Yorkshire, have found evidence of survival inequalities occurring between ethnic groups in children under the age of 16 years [8,9]. However, our results describing the independent effects on survival of being south Asian ethnic origin, provide an important benchmark from which to judge the impact of the National Institute for Health and Clinical Excellence Improving Outcomes Guidance (IOG) for Children and Young People, due to be implemented by 2011 [31].
Survival from childhood acute lymphoblastic leukaemia: The impact of social inequality in the United Kingdom
2012, European Journal of CancerChildhood cancer survival in Ireland: Temporal, regional and deprivation-related patterns
2011, European Journal of CancerCitation Excerpt :However, significant variation in survival was noted amongst regions of residence, especially within the first six months after diagnosis, having adjusted for age, sex and deprivation.12 A study of childhood cancer patients in Yorkshire during 1974–1995 noted significant declines in (unadjusted) survival across five deprivation strata for all cancers combined, leukaemias and central nervous system tumours, but not after adjustment for age, ethnicity and other factors.11 Similarly, no significant socio-economic survival gradient was noted for children with cancer across England and Wales during 1971–1995.5
Inequalities in childhood cancer mortality according to parental socioeconomic position: A birth cohort study in South Korea
2011, Social Science and MedicineCitation Excerpt :Relative survival was calculated from cancer registry and census data according to socioeconomic positions based on an area deprivation index. McKinny et al. failed to see inequalities in childhood cancer mortality in Yorkshire, UK (McKinney et al., 1999). A survival analysis was performed on a population-based cancer registry of childhood malignancies in Yorkshire according to an area deprivation index.