|The following article features coverage from the American Society of Hematology 2020 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.|
Neighborhood socioeconomic status (SES) accounted for at least some of the racial disparity found for death from leukemia and all causes among Black and Hispanic individuals with acute myeloid leukemia (AML), according to results of a study presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting and Exposition.
Black people with AML who lived in socioeconomically disadvantaged neighborhoods in metropolitan Chicago were 48% more likely to die from the disease, and Hispanic people were 20% more likely to die from the disease, than non-Hispanic White counterparts, according to Irum Khan, MD, of University of Illinois at Chicago.
Previous research has shown that these populations have higher mortality rates than non-Hispanic White patients despite a lower incidence of disease, more favorable genetics, and a younger age at diagnosis. In this study, Dr Khan and colleagues investigated how structural violence and specifically neighborhood SES affected racial/ethnic differences in leukemia-specific survival.
The study included 822 patients diagnosed with acute myeloid leukemia (AML) from 2012 to 2018 across 6 academic centers in the Chicago area. The researchers used Census tract data to compute tract disadvantage (percent of families with incomes below the poverty line, families receiving public assistance, persons who were unemployed, and female-headed households with children) and tract affluence (percent of families with incomes of $75,000 or more, adults with a college education of more, and labor force in professional and managerial occupations) scores.
Non-Hispanic White patients were twice as likely to have private insurance as non-Hispanic Black patients (51% vs 25%). In addition, non-Hispanic Black and Hispanic patients tended to reside in more disadvantaged, less affluent areas. Hispanic patients were younger at diagnosis, and Black and Hispanic patients were more likely to be morbidly obese.
Choice of first-line treatment was not significantly different by race or tract disadvantage. However, the rate of allogeneic transplant was different by race, age, insurance status, tract disadvantage, and European Leukemia Network score.
Non-Hispanic White patients had significantly lower rates of treatment complications compared with non-Hispanic Black patients and Hispanic patients (25% vs 39% and 42%, respectively). In addition, ICU admission rates were significantly higher in patients with low-tract affluence.
After adjustment for age, sex, and the institution in which they were treated, census tract affluence, disadvantage, and segregation were all significant predictors of leukemia-related death. Census tract SES variables accounted for 81% of the Black/White disparity in AML-related death.
“When we eliminate the SES tract disparity, the leukemia death difference between Black and White AML patients decreases from 58% to 11%,” Dr Khan said. “While this field is in its infancy, our analysis suggests that incorporating validated measures of social determinants of health into clinical care is likely to contribute significantly to narrowing disparities in leukemia survival.”
Disclosures: Some of the presenters disclosed financial relationships with the pharmaceutical industry and/or the medical device industry. For a full list of disclosures, please refer to the presentation abstract.
Read more of Cancer Therapy Advisor‘s coverage of the ASH 2020 meeting by visiting the conference page.
Abraham I, Rauscher G, Patel AA, et al. The role of structural violence in acute myeloid leukemia outcomes. Presented at: the 62nd American Society of Hematology (ASH) Annual Meeting and Exposition; December 5-8, 2020. Abstract 217.