Background
Childhood cancer mortality is widely recognized as a sensitive indicator of health system performance, reflecting timely diagnosis, access to specialized care, and continuity of treatment. In low- and middle-income countries (LMICs), deficiencies in these domains translate into avoidable deaths and persistent inequities. In Mexico, successive health system reforms have sought to improve access to care; however, their population-level impact on childhood cancer mortality and equity has not been comprehensively assessed.

Objectives
To examine long-term trends and sociodemographic disparities in childhood cancer mortality in Mexico and to identify actionable gaps relevant for cancer control, equity, and health system strengthening in LMICs.

Methods
We conducted a population-based analysis of childhood cancer mortality among individuals aged 0–19 years in Mexico from 1998 to 2023 using national death registry data. Age-standardized mortality rates were estimated overall and stratified by sex, age group, cancer type, geographic region, locality (urban, semi-urban, rural), educational level, social security coverage, deprivation index, and state-level availability of tertiary healthcare units. Temporal trends were evaluated using joinpoint regression to estimate annual percent changes (APC) and average annual percent changes (AAPC).

Results
Between 1998 and 2023, a total of 38,434 childhood cancer deaths were recorded in Mexico, corresponding to an age-standardized mortality rate of 3.26 per 100,000 population. Overall childhood cancer mortality declined modestly over the study period (AAPC −0.27%), followed by stagnation or recent increases in several population subgroups. Acute lymphoblastic leukemia accounted for nearly half of all deaths and largely drove overall mortality patterns. Marked inequalities persisted: mortality rates were consistently higher among children without social security coverage, those living in highly deprived areas, rural localities, and regions with lower availability of tertiary-level healthcare units. Declines were more pronounced in populations with greater healthcare access, while disadvantaged groups experienced slower improvements or unfavorable recent trends.

Conclusions / Implications
Despite overall progress, childhood cancer mortality in Mexico remains strongly patterned by social disadvantage and health system capacity, indicating a substantial burden of potentially avoidable deaths. Mortality trends function as a sentinel indicator of inequities in timely diagnosis and effective treatment. These findings provide actionable evidence to inform cancer control policies, prioritize resource allocation, and strengthen referral networks and specialized care capacity in LMICs. Routine mortality surveillance can play a critical role in monitoring equity and guiding implementation strategies aimed at improving childhood cancer outcomes.

Trends in age-adjusted childhood cancer mortality rates in Mexico, 1998–2023 (Joinpoint regression analysis)