Health Insurance as a Mediator of Neighborhood Deprivation and Pediatric Cancer Survival: An Analysis of State Cancer Registry Data

Emma Hymel; Cheng Zheng; Jenna Allison; Kendra L Ratnapradipa; Edward S Peters; Sarah H Nash; Mei-Chin Hsieh; Shinobu Watanabe-Galloway

doi:10.1002/cam4.71755

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Health Insurance as a Mediator of Neighborhood Deprivation and Pediatric Cancer Survival: An Analysis of State Cancer Registry Data

Journal article

Open access

Peer reviewed

Health Insurance as a Mediator of Neighborhood Deprivation and Pediatric Cancer Survival: An Analysis of State Cancer Registry Data

Emma Hymel, Cheng Zheng, Jenna Allison, Kendra L Ratnapradipa, Edward S Peters, Sarah H Nash, Mei-Chin Hsieh and Shinobu Watanabe-Galloway

Cancer medicine (Malden, MA), Vol.15(4), e71755

04/2026

DOI: 10.1002/cam4.71755

PMID: 41891382

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Abstract

To develop interventions to reduce neighborhood-level disparities in pediatric cancer outcomes, it is necessary to understand their underlying mechanisms. It has been suggested that individual-level health insurance is a mediator of neighborhood deprivation and pediatric cancer survival. This study was a population-based longitudinal study of children with cancer from 2000 to 2020 in the Iowa Cancer Registry and Louisiana Tumor Registry. Neighborhood deprivation was measured using the Area Deprivation Index. Log-binomial regression models were used to identify predictors of health insurance status at diagnosis. Cox regression models were used to assess the association between health insurance status at diagnosis and cancer-specific survival. Causal mediation analyses were conducted to investigate whether health insurance status serves as a mediator of the relationship between neighborhood deprivation and survival. The study included 5782 children with cancer: 2069 in Iowa and 3723 in Louisiana. Children in more deprived neighborhoods, non-White children, and children in Louisiana were more likely to have non-private insurance. Compared with children with private insurance, those with non-private insurance had a 32% higher hazard of cancer death (aHR = 1.32, 95% CI: 1.13-1.55). Insurance status was observed to mediate the association between ADI and cancer-specific survival, mediating 7.33%-14.59% of the estimated association. While individual-level health insurance status was a mediator of neighborhood-level disparities in pediatric cancer survival, it did not explain a large proportion of the observed disparities. This suggests that structural and systemic factors, beyond just individual insurance coverage, may play a significant role in shaping pediatric cancer outcomes.

Adolescent

Child

Child, Preschool

Female

Healthcare Disparities - statistics & numerical data

Humans

Infant

Insurance Coverage - statistics & numerical data

Insurance, Health - statistics & numerical data

Iowa - epidemiology

Longitudinal Studies

Louisiana - epidemiology

Male

Neighborhood Characteristics - statistics & numerical data

Neoplasms - mortality

Neoplasms - therapy

Registries - statistics & numerical data

Residence Characteristics - statistics & numerical data

Details

Title: Subtitle: Health Insurance as a Mediator of Neighborhood Deprivation and Pediatric Cancer Survival: An Analysis of State Cancer Registry Data
Creators: Emma Hymel - University of Nebraska Medical Center
Cheng Zheng - University of Nebraska Medical Center
Jenna Allison - University of Nebraska Medical Center
Kendra L Ratnapradipa - University of Nebraska Medical Center
Edward S Peters - University of Nebraska Medical Center
Sarah H Nash - University of Iowa
Mei-Chin Hsieh - Louisiana State University Health Sciences Center New Orleans
Shinobu Watanabe-Galloway - University of Nebraska Medical Center
Resource Type: Journal article
Publication Details: Cancer medicine (Malden, MA), Vol.15(4), e71755
DOI: 10.1002/cam4.71755
PMID: 41891382
NLM abbreviation: Cancer Med
ISSN: 2045-7634
eISSN: 2045-7634
Publisher: WILEY
Grant note: Child Health Research Institute, University of Nebraska Medical Center
Language: English
Date published: 04/2026
Academic Unit: Epidemiology; Community and Behavioral Health
Record Identifier: 9985149412702771

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