Structural racism is a mediator of disparities in acute myeloid leukemia outcomes
Structural racism is a mediator of disparities in acute myeloid leukemia outcomes
复制标题
DOI：
10.1182/blood.2021012830
复制
发表时间：
2022-04-07
期刊：
影响因子：
20.3
通讯作者：
Khan, Irum
中科院分区：
文献类型：
--
作者：
Abraham, Ivy Elizabeth;Rauscher, Garth H.;Khan, Irum
非西班牙裔黑人（NHB）和西班牙裔急性髓性白血病（AML）患者的死亡率高于非西班牙裔白人（NHW）患者，尽管他们更有利的遗传条件和更年轻的年龄。对来自6个城市癌症中心的822名成年AML患者进行了离散生存分析，结果显示，与NHW患者相比，NHB患者（风险比[HR] = 1.59； 95%可信区间[CI]: 1.15, 2.22）和西班牙裔患者（HR = 1.25; 95% CI: 0.88, 1.79）的生存率较低。然后进行了差异的多层次分析，以调查结构性种族主义的邻里措施对种族/民族生存差异的贡献。人口普查区劣势和富裕得分分别计算。通过结构性种族主义（人口普查区劣势、富裕和隔离）、肿瘤生物学（欧洲白血病网络风险和继发性白血病）、医疗保健可及性（保险和临床试验登记）、合并症、治疗模式（诱导强度和移植利用）和诱导化疗期间重症监护病房（ICU）入住6个复合变量对组间白血病死亡风险进行中介分析。引人注目的是，人口普查区测量几乎解释了NHB-NHW和西班牙裔- nhw在白血病死亡方面的所有差异。治疗模式，包括诱导强度和同种异体移植，以及在诱导化疗期间ICU入院评估的治疗并发症，是AML生存差异的额外介质。这是第一个正式测试AML生存差异介质的研究，强调了研究结构性种族主义与已知预后和治疗因素相互作用影响白血病结局的机制的必要性。
Non-Hispanic Black (NHB) and Hispanic patients with acute myeloid leukemia (AML) have higher mortality rates than non-Hispanic White (NHW) patients despite more favorable genetics and younger age. A discrete survival analysis was performed on 822 adult patients with AML from 6 urban cancer centers and revealed inferior survival among NHB (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.15, 2.22) and Hispanic (HR = 1.25; 95% CI: 0.88, 1.79) patients compared with NHW patients. A multilevel analysis of disparities was then conducted to investigate the contribution of neighborhood measures of structural racism on racial/ethnic differences in survival. Census tract disadvantage and affluence scores were individually calculated. Mediation analysis of hazard of leukemia death between groups was examined across 6 composite variables: structural racism (census tract disadvantage, affluence, and segregation), tumor biology (European Leukemia Network risk and secondary leukemia), health care access (insurance and clinical trial enrollment), comorbidities, treatment patterns (induction intensity and transplant utilization), and intensive care unit (ICU) admission during induction chemotherapy. Strikingly, census tract measures accounted for nearly all of the NHB-NHW and Hispanic-NHW disparity in leukemia death. Treatment patterns, including induction intensity and allogeneic transplant, and treatment complications, as assessed by ICU admission during induction chemotherapy, were additional mediators of survival disparities in AML. This is the first study to formally test mediators for observed disparities in AML survival and highlights the need to investigate the mechanisms by which structural racism interacts with known prognostic and treatment factors to influence leukemia outcomes.