Inequitable poverty exposures: A subspecialty opportunity to address disparities

Subspecialty pediatrics have lagged behind primary care pediatrics in recognizing adverse social determinants of health (SDOH) as salient to outcomes, key drivers of inequity, and worthy of systematic investigation. A population frequently hospitalized with chronic illness with well-defined inequities is children with cancer. More than 1 in 5 pediatric oncology families report low-income, and at least 1 household material hardship (HMH; food, housing, or utility insecurity) at diagnosis. Identifying whether children from marginalized racial/ethnic groups are disproportionately exposed to poverty, a modifiable SDOH, can inform intervention opportunities for children with chronic illness to mitigate disparities. We leveraged parent-reported poverty data collected as a prospective aim of a clinical trial for children with newly diagnosed acute lymphoblastic leukemia (ALL) to characterize modifiable poverty exposures by race/ethnicity.