Date Approved


Graduate Degree Type


Degree Name

Public Health (M.P.H.)

Degree Program

Public Health

First Advisor

Jeffrey Wing

Second Advisor

Karen Niemchick

Third Advisor

Nicholas Andersen

Academic Year



Acute lymphoblastic leukemia (ALL) is the most common type of cancer diagnosed in children. However, little is known about how socioeconomic status (SES) influences the outcomes of children diagnosed with ALL. The goal of the research study was to understand how SES impacted the outcomes of children diagnosed with ALL, with a particular interest in children living in West Michigan. Children ages 0-14 years who received treatment for ALL at Spectrum Health’s Helen DeVos Children’s Hospital’s Pediatric Hematology and Oncology program between the years 2002-2011 were considered for this study. Eligible participant’s zip codes and dates of relapse/death were obtained through retrospective chart reviews to investigate the association of interest. Zip codes were utilized to create neighborhood SES scores based on census data related to education, occupation, and household income. Time to relapse/death was determined to calculate five-year event-free survival. Differences in survival across socioeconomic tertiles were evaluated using Kaplan-Meier survival analysis, with Coxproportional hazard regression conducted to describe the association between all collected variables. Statistical analyses revealed that children of higher socioeconomic standing were shown to have an increased risk of relapse or death compared to children of lower socioeconomic standing, however these findings did not show a statistically significant difference between the neighborhood socioeconomic tertiles. Although previous research has shown that those of higher SES tend to have better overall health and better health outcomes, compared to those of lower SES, this research study suggests that these differences may not always occur as expected. Decreased exposure to early childhood infectious agents by way of improved hygiene and changes in childcare may explain why children of higher socioeconomic may be at greater risk of poor health outcomes compared to those of lower socioeconomic standing. These findings may also indicate that differences in outcomes between various socioeconomic groups may have diminished over the period of interest through the use of better health communication and health services.

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Public Health Commons