ORIGINAL RESEARCH article
Front. Oncol.
Sec. Pediatric Oncology
This article is part of the Research TopicCancer Survival in ChildrenView all 5 articles
The Impact of Environmental Contaminants, Air Pollution, and Social Deprivation on Childhood Leukemia Survival in California
Provisionally accepted
Fernando Hernandez1*
Eric Stewart1Libby M Morimoto1Alice Y Kang1Lena E Winestone2,3
Catherine METAYER1*- 1University of California Berkeley School of Public Health, Berkeley, United States
- 2UCSF Benioff Children's Hospital, San Francisco, United States
- 3University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, United States
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Introduction: Despite advances in leukemia treatment, disadvantaged children experience worse outcomes. We evaluated the impact of intertwined socioeconomic and pollution burdens on childhood leukemia survival, focusing on ambient air pollution, a known carcinogen. Methods: Participant data were obtained from the California Childhood Leukemia Study (1995-2015) and linked by diagnosis residence to the CalEnviroScreen (CES) 3.0 database, that characterizes neighborhood pollution burden and area-based population vulnerabilities across California. Five-year survival analyses were performed using Kaplan-Meier estimators and Cox proportional hazards ratio (HR) models with 95% confidence intervals (CI), adjusting for individual socio-demographic and clinical prognostic factors. Results: 124 out of 1,210 children with acute lymphoblastic leukemia (ALL) died within 5 years of diagnosis. Living in an area with a medium/high CES composite score for both pollution and population/social burdens was associated with decreased ALL survival, compared to a low CES score (HR=2.19; 95% CI: 1.19-3.91), with population/social burden driving this observation (HR=1.85; 95% CI: 1.06-3.21). HRs for medium/high composite, particulate matter (PM2.5), and ozone scores were the highest among children with ALL molecular subtypes known to have unfavorable prognosis (i.e. high-hyperdiploidy negative, CDKN2A and IKZF1 deletions). For acute myeloid leukemia (AML) (49 deaths among 178 cases), living in an area with medium/high score for population/social burden was associated with an increased risk of death (HR=2.21; 95% CI: 0.99-4.94). Conclusion: High cumulative community burden, especially social deprivation, was associated with reduced survival of childhood ALL and AML, while high levels of PM2.5 and ozone were associated with reduced survival in specific ALL subtypes.
Keywords: Children, Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, CalEnviroScreen, Air Pollution
Received: 14 Aug 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Hernandez, Stewart, Morimoto, Kang, Winestone and METAYER. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Fernando Hernandez, fernandohz2020@gmail.com
Catherine METAYER, cmetayer@berkeley.edu
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