Early mortality in children with cancer in Denmark and Sweden: The role of social background in a setting with universal healthcare

Hanna Mogensen*, Friederike Erdmann, Luzius Mader, Gitte Vrelits Sørensen, Mats Talbäck, Thomas Tjørnelund Nielsen, Henrik Hasle, Mats Heyman, Jeanette Falck Winther, Maria Feychting, Giorgio Tettamanti, Line Kenborg

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review


Socioeconomic differences in overall survival from childhood cancer have been shown previously, but the underlying mechanisms remain unclear. We aimed to investigate if social inequalities were seen already for early mortality in settings with universal healthcare. From national registers, all children diagnosed with cancer at ages 0-19 years, during 1991-2014, in Sweden and Denmark, were identified, and information on parental social characteristics was collected. We estimated odds ratios (OR) and 95% confidence intervals (CI) of early mortality (death within 90 days after cancer diagnosis) by parental education, income, employment, cohabitation, and country of birth using logistic regression. For children with acute lymphoblastic leukaemia (ALL), clinical characteristics were obtained. Among 13,926 included children, 355 (2.5%) died within 90 days after diagnosis. Indications of higher early mortality were seen among the disadvantaged groups, with the most pronounced associations observed for maternal education (OR adj_Low_vs_High 1.65 [95% CI 1.22-2.23]) and income (OR adj_Q1(lowest)_vs_Q4(highest) 1.77 [1.25-2.49]). We found attenuated or null associations between social characteristics and later mortality (deaths occurring 1-5 years after cancer diagnosis). In children with ALL, the associations between social factors and early mortality remained unchanged when adjusting for potential mediation by clinical characteristics. In conclusion, this population-based cohort study indicated differences in early mortality after childhood cancer by social background, also in countries with universal healthcare. Social differences occurring this early in the disease course requires further investigation, also regarding the timing of diagnosis.

Original languageEnglish
JournalInternational Journal of Cancer
Pages (from-to)1719-1730
Number of pages12
Publication statusPublished - 15 May 2024


  • childhood cancer
  • cohort
  • early mortality
  • register-based study
  • socioeconomic factors


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