Living along the Texas-Mexico border is associated with worse survival in children with acute lymphoblastic leukemia (ALL), according to study results published in Cancer.1
The study showed that children with ALL who lived near the border had a 30% higher risk of death than children living in non-border areas. However, children with acute myeloid leukemia (AML) did not have a higher risk of death if they lived near the border.
This retrospective, population-based study used data from the Texas Cancer Registry and included patients aged 0 to 19 years who were diagnosed with ALL or AML from 1995 to 2017.
Results in ALL Patients
Of the 6002 patients with ALL, 93.8% were Hispanic, 14.2% lived along the border, and 77.5% lived in higher poverty census tracts. The median age at diagnosis was 5 years, and the median follow‐up was 8.6 years.
The researchers found that border residence was significantly associated with OS (P <.001). The 5‐year OS rate was 85.8% for patients living in non-border areas and 77.5% for those living near the border.
In an unadjusted analysis, border residence was associated with a 58% increased risk of death (hazard ratio [HR], 1.58; 95% CI, 1.35-1.84; P <.001). In an adjusted analysis, border residence was associated with a 30% increased risk of death (adjusted HR [aHR], 1.30; 95% CI, 1.09-1.54; P =.003).
Race/ethnicity was also associated with OS. The risk of death was higher among Hispanic children (aHR, 1.24; 95% CI, 1.06-1.47; P =.009) and non-Hispanic Black children (aHR, 1.38; 95% CI, 1.07-1.77; P =.014), compared with non-Hispanic White children.
In addition, children living in the highest poverty census tracts had a higher risk of death than children living in the lowest poverty census tracts (aHR, 1.51; 95% CI, 1.20-1.91; P <.001).
Results in AML Patients
Of the 1279 patients with AML, 93.5% were Hispanic, 14.4% lived along the border, and 77.3% lived in high poverty census tracts. The median age at diagnosis was 9 years, and the median follow‐up was 4.5 years.
There was a trend toward an association between OS and border residence among AML patients, but the significance threshold was not met (P =.06). The 5‐year OS rate was 60.1% for children living in non-border areas and 53.6% for children living near the border.
Border residence was not significantly associated with death in an unadjusted analysis or an adjusted analysis. Likewise, race/ethnicity and poverty level were not significantly associated with OS among the AML patients.
Call to Action
“Additional studies are urgently needed to identify the factors driving these disparities to effectively design multilevel interventions and influence state and national cancer control programs,” the researchers wrote.
Authors of a related editorial wrote that these results “urge a call to action to improve dismal survival by identifying reversible drivers of outcomes and targets for interventions to mitigate inequities.”2
“We urgently call for the attention of public health leaders and health care providers in both the United States and Mexico to mitigate the health disparities suffered by immigrants, a population that plays a vital role in the economies and social fabric of these two countries,” the editorialists wrote.
1. Castellanos MI, Oluyomi AO, Chambers TM, et al. Ethnic disparities in childhood leukemia survival by border residence: A Texas population‐based analysis. Cancer. Published online February 21, 2023. doi:10.1002/cncr.34636
2. Aristizabal P, Thornburg CD, Young J. At the border: A call to action for health equity for children with leukemia. Cancer. Published online February 21, 2023. doi:10.1002/cncr.34629