早期诊断和治疗对于提高低收入和中等收入国家（LMIC）儿童癌症生存率至关重要。综合指数越来越被用于比较各个健康领域的国家表现。我们的研究旨在开发一个综合脆弱性指数，用于衡量在LMIC延误治疗对儿童癌症死亡风险的影响，并比较不同国家之间的脆弱性指数得分。 这个综合脆弱性指数是通过十个步骤建立的。之前的系统综述研究对于发现儿童癌症延误治疗的决定因素提供了指导。我们从多个大型数据集中收集了曝露变量（延误治疗的决定因素）和结果变量（儿童癌症相关的死亡），并使用回归模型分析数据以发现导致儿童癌症死亡的延误治疗的决定因素。显著指标按照社会生态模型聚合成不同的领域。我们使用地理空间工具来总结和比较不同国家之间的综合脆弱性指数得分。 我们发现，在LMIC中，预期寿命、母亲受教育程度、生育率、病理服务的可用性、骨髓移植能力、治疗服务（化疗、放疗或手术）、每10,000人口中的药剂师数量、国家收入水平和自费医疗支出与儿童癌症死亡有显著相关性。亚撒哈拉地区的脆弱性水平最高。 我们的综合脆弱性指数可以作为有价值的政策决策工具，帮助监测各国表现并指导减少LMIC儿童癌症延误治疗干预措施的实施。没有其他要补充的内容。有关摘要的中文、葡萄牙语、阿拉伯语、西班牙语和斯瓦希里语翻译请参见“补充材料”部分。 © 2023作者。由Elsevier Ltd.发表。本文是根据CC BY-NC-ND 4.0许可证发布的开放获取文章。Elsevier Ltd.保留所有权利。

Early access to diagnosis and care is essential to improve rates of survival from childhood cancer, particularly in low-income and middle-income countries (LMICs). Composite indices are increasingly used to compare country performance in many health fields. We aimed to develop a composite vulnerability index of risk of mortality associated with delays in care for childhood cancer in LMICs, and to compare the vulnerability index scores across countries.The composite vulnerability index was built in ten steps. A previous systematic review of determinants of delays in cancer care for children guided data selection. We collected exposure variables (determinants of delays in care) and outcome variables (childhood cancer-related mortality) from several large datasets. Data were analysed with regression models to identify determinants of delays in care that contribute to childhood cancer mortality. Significant indicators were aggregated into domains according to the socio-ecological model. We used geospatial tools to summarise and compare the composite vulnerability index scores across countries.We found that life expectancy, maternal education, fertility rate, availability of pathology services, bone marrow transplantation capacity, availability of treatment services (chemotherapy, radiotherapy, or surgery), number of pharmacists per 10 000 population, country income level, and out-of-pocket health expenditure were significantly associated with cancer mortality for children in LMICs. The highest levels of vulnerability were found in sub-Saharan Africa.Our composite vulnerability index can potentially serve as a valuable policy decision tool to help monitor country performance and guide interventions to reduce delays in care for children with cancer in LMICs.None.For the Chinese, Portuguese, Arabic, Spanish and Swahili translations of the abstract see Supplementary Materials section.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.