Spatiotemporal analysis and socioeconomic determinants of pediatric lymphoid leukemias mortality in Brazil from 2000 to 2021: an ecological study

Background Leukemias are the most frequent pediatric cancers, and socioeconomic factors influence their outcomes. In Brazil, regional disparities in pediatric lymphoid leukemias (LL) mortality have been reported. Their determinants require further investigation. We aimed to describe pediatric LL mortality and its association with socioeconomic, demographic, and health system characteristics in Brazil. Methods This ecological study included the Brazilian state population aged 0–19 years from 2000 to 2021. Crude and age-specific mortality rates were the primary outcome. Annual percentage change estimated mortality trends. Eleven socioeconomic characteristics were grouped in two components using principal component analysis (PCA): "development index" and "Primary Health Care (PHC) index". Generalized additive mixed models explored their associations with mortality. Findings Pediatric LL mortality increased in Brazil, mainly in North and Northeast (NE). South and Southeast showed stable or declining rates. The development index association with age-specific mortality rates (ASMR) increase was crescent in worse socioeconomic contexts and decrescent in better ones. The PHC index showed a non-significant association with ASMR decreases in NE states. Interpretation Regional disparities in pediatric LL mortality were associated with socioeconomic inequalities. More vulnerable states experienced mortality increases and delayed benefits of economic and health system development. PHC expansion alone was insufficient to overcome disparities. Strengthening health workers training and treatment capacity is essential. Funding Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro, INCT BioOncoPed, and the International Society of Paediatric Oncology.