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, ages 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 and 11,907 controls). We tested associations of individual-level (maternal education) and neighborhood-level (census tract composite index) SES using logistic mixed models. In crude 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 birth weight-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.
Bibliographical noteFunding Information:
Health, Minneapolis, Minnesota (Rebecca D. Kehm, Theresa L. Osypuk); University of Minnesota, Division of Epidemiology and Clinical Research, Department of Pediatrics, Minneapolis, Minnesota (Logan G. Spector, Jenny N. Poynter); and University of Minnesota School of Public Health, Division of Biostatistics, Minneapolis, Minnesota (David M. Vock). This work was supported by the National Institutes of Health Translational Pediatric Cancer Epidemiology Training Grant (T32CA099936).
© 2018 The Author(s).
Copyright 2019 Elsevier B.V., All rights reserved.
- childhood cancer incidence
- multilevel methods
- socioeconomic status