The Role of Childhood Opportunity in Acute Lymphoblastic Leukemia Survival in New Jersey: 2004–2020.

This article examines the association between neighborhood resources, measured by the Child Opportunity Index 3.0 (COI), and overall survival among 1,343 children and adolescents diagnosed with acute lymphoblastic leukemia (ALL) in New Jersey (NJ) from 2004 to 2020. Findings indicate that children living in census tracts with very low COI scores had a significantly lower five-year overall survival rate (87%) compared to those in very high opportunity areas (96%), with a 2.6-fold increased risk of death after adjusting for age, leukemia subtype, and ethnicity. The study identifies socioeconomic factors within the COI's social and economic domain as the primary drivers of these disparities, while no survival differences were found by race or ethnicity after adjustment. These results highlight the impact of inequitable neighborhood opportunity on childhood ALL outcomes in NJ and support policy efforts aimed at more equitable distribution of social and economic resources to improve pediatric cancer survival.