Introduction One of the leading reasons for the improved survival rate of paediatric ALL has been the main use of risk-stratified therapy. Several studies conducted in the US and other countries have demonstrated that low socio-economic status is associated with lower health outcomes in children with cancer.

A retrospective study has been conducted to evaluate if socio-economic deprivation is linked to reduced overall survival (OS) in patients with B-ALL (0-19years) despite an equitable healthcare system in England.

Methods The National Cancer Registration Dataset (NCRD) was used. The NCRD holds the population-based national cancer registry for England.The identification of patients aged 0- 19 years and diagnosed with B-ALL between the 1st of January 2013 and the 31st od December 2020 was done in the NCRD dataset using the World Health Organization (WHO) International Classification of Diseases for Oncology (ICD-O3) codes. The OS with 95% confidence (95% CI) after the diagnosis of B-ALL was assessed by the use of the Kaplan Meier methodology.

Results 1228 patients with B-ALL ( aged 0-19 years) were identified with 667 patients with B-ALL diagnosed in the year 2013-2015 and 561 patients diagnosed with B-ALL diagnosed in the year 2016-2018. In the year 2013-2015, there was 176 male patients aged 0-4 years, 92 male patients aged 5-9 years, 47 male patients aged 10-14 years, 34 male patients aged 15-19 years, 188 female patients aged 0-4 years, 72 female patients aged 5-9 years, 35 female patients aged 10-14 years, 23 patients aged 15-19 years. The ethnicity of the patients with B-ALL diagnosed in the year 2013-2015 were 526 white patients, 81 patients were Asian (excluding Chinese), 12 patients were of Black ethnicity, 24 patients were of mixed ethnicity, 20 patients were of other ethnicity and 1 patient's ethnicity were unknown.

Of the 667 B-ALL patients diagnosed in the year 2013-2015, 164 patients lived in the most deprived areas (Index of multiple deprivation – 1), 137 patients lived in areas of IMD-2, 113 patients lived in IMD -3, 99 patients lived in IMD- 4, 149 patients lived IMD -5 (least deprived areas). The OS rates for patients living in the most deprived areas with IMD-1 at 1 year and 5 years was 95.1% (95 CI 90.5%-97.5%) and 86% (95 CI 79.7%- 90.4%). The OS at 1 year and 5 years of the patients living in the least deprived areas with IMD-5 was 98% (CI 93.9% - 99.3%) and 95.3% ( 90.4%-97.7%) respectively.

For the year 2016-2018, there was 561 patients diagnosed with B-ALL, of whom 130 male patients were aged 0-4 years, 86 male patients were aged 5-8 years, 42 male patients were aged 10-14 years, 46 male patients were aged 15-19, 125 female patients were aged 0-4 years, 70 patients were aged 5-9 female patients, 39 female patients were aged 10-14 years, 22 female patients were aged 15-19 years. The ethnicity of the patients with B-ALL in the 2016-2020 cohort comprised of 422 patients who were of white ethnicity, 79 patients were of Asian (Excluding chinese) ethnicity, 12 patients were of black ethnicity, 1 patient was of Chinese ethnicity, 22 patients were of mixed ethnicity, 21 patients were of another ethnicity and 3 patients ethnicity were unknown. Furthermore, within the 2016-2018 cohort, there was 120 patients resided in the most deprived areas (IMD-1), 111 patients lived in IMD-2, 117 patients lived in IMD-3, 104 patients lived in IMD -4, 109 patients lived in the IMD-5 (least deprived areas). The OS at 1 year and 3 years for the patients living in most deprived areas with IMD-5 was 95.8% ((95 CI – 90.3 %-98.2%), 91.7% (95 CI 85.1%-95.4%) whereas the OS at 1 year and 3 years for patients in the least deprived areas with IMD-5 was 99.1% (CI 93.6%- 99.9%) and 95.4% (95 CI 89.2%-98%).

Conclusion This is the first study performed in England showing that despite an equitable healthcare system the OS of patients with B-ALL aged (0-19 years) is higher for patients who resides in the least deprived areas. Socio-economic deprivation, a modifiable risk factor might play a role in OS of patients with B-ALL although it could also be a combination of the biology of the disease and the social factors such as reduced transport facility, nutrition, amongst other social factors. It could imply that those parents struggle to find time to have time off work to take their chidren to appointments leading to reduced surveillance of efficacy of treatment. However, more studies are required to reach definite conclusion in the future.

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2025
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