Elsevier

European Journal of Cancer

Volume 35, Issue 13, December 1999, Pages 1816-1823
European Journal of Cancer

Original Paper
Survival from childhood cancer in Yorkshire, U.K.: effect of ethnicity and socio-economic status

https://doi.org/10.1016/S0959-8049(99)00173-2Get rights and content

Abstract

The effect of ethnicity and socio-economic status on the survival of a population-based cohort of 1979 children diagnosed with cancer between 1974 and 1995 was investigated. Ethnicity was assigned by computer algorithms and visual inspection as south Asian (or not) for each child, based on their full name. Socio-economic status was measured using the Carstairs index, based on census areas of case residence at diagnosis. 15 children (0.8%) were lost to follow-up. Log-rank tests showed survival from all cancers did not differ between south Asians and other children and no increased risk was observed for south Asians in any diagnostic category, although numbers were small. Increasing levels of deprivation were associated with significant trends of poorer survival from all cancers, leukaemias and brain tumours. Risk of death was typically higher for children from the most deprived areas although differences were not statistically significant after accounting for other factors including ethnicity. Taking all children with malignant disease together, neither ethnicity nor socio-economic status appear to influence survival after taking other factors into consideration.

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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