Territorial Socioeconomic Vulnerability and Clinical Outcomes in Pediatric Cancer at a Colombian Referral Center.
In a retrospective study of 434 pediatric cancer patients at a Colombian referral center, older age, non-hematologic malignancy, and subsidized insurance were associated with adverse outcomes, whereas territorial multidimensional poverty and rural residence were not independently associated after adjustment.
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In a retrospective study of 434 pediatric cancer patients at a Colombian referral center, older age, non-hematologic malignancy, and subsidized insurance were associated with adverse outcomes, whereas territorial multidimensional poverty and rural residence were not independently associated after adjustment.
Research significance
The evidence identifies clinical and insurance-related markers of higher outcome risk and documents substantial territorial deprivation; it supports the inference—but does not demonstrate—that combining these indicators could guide targeted navigation, supportive services, referral strategies, or equity-focused surveillance to improve outcomes.
Source abstract
Background/Objectives: Childhood cancer outcomes are influenced by clinical, socioeconomic, and territorial factors, particularly in resource-limited settings. This study characterized pediatric cancer patients from Córdoba and Sucre, Colombia, and evaluated factors associated with clinical outcomes in a regional referral center. Methods: A retrospective hospital-based study included 434 patients aged 0-18 years diagnosed between 2018 and 2024. Sociodemographic, clinical, and territorial socioeconomic variables were analyzed using the Multidimensional Poverty Index (MPI). Clinical outcomes were classified as favorable, non-favorable, or death. Firth-penalized logistic regression models were used to assess adjusted associations. Results: Hematologic malignancies predominated (65.9%), with acute lymphoblastic leukemia as the most frequent diagnosis. Most patients came from municipalities with moderate or high multidimensional poverty (85.2%), and the rural territories of origin showed greater deprivation in education, employment, housing, water access, and sanitation. Favorable outcomes occurred in 82.9% of patients, while 8.5% had non-favorable outcomes and 8.5% died. Older age and non-hematologic malignancies were associated with non-favorable outcomes. Mortality was associated with older age, subsidized health insurance, and non-hematologic malignancies. MPI and rural residence were not independently associated with outcomes after adjustment. Conclusions: Although MPI was not independently associated with clinical outcomes, it identified substantial territorial deprivation. Integrating clinical and territorial indicators may support equity-oriented surveillance and pediatric oncology interventions.