Racial/ethnic and socioeconomic disparities in survival among children with acute lymphoblastic leukemia in California, 1988-2011: A population-based observational study
Racial/ethnic and socioeconomic disparities in survival among children with acute lymphoblastic leukemia in California, 1988-2011: A population-based observational study
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DOI：
10.1002/pbc.25544
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发表时间：
2015-10-01
影响因子：
3.2
通讯作者：
Keegan, Theresa H. M.
中科院分区：
文献类型：
--
作者：
Abrahao, Renata;Lichtensztajn, Daphne Y.;Keegan, Theresa H. M.
背景尽管治疗取得了进展，但在美国，非白色儿童的急性淋巴细胞白血病（ALL）生存率仍然低于白色儿童。我们调查了种族/民族和社会经济地位（SES）与survival.ProceduresWe分析了9，295名加州儿童（3，251名白人，4，890名西班牙裔，796名亚洲人和358名黑人），年龄19岁，在1988-2011年期间诊断为首次原发ALL。我们使用Kaplan-Meier方法估计诊断后1年、5年和10年的生存率。通过考克斯回归模型估计种族/民族，SES和临床因素的死亡风险比。随着时间的推移，ALL后的生存率稳步提高，但种族/民族之间的不平等仍然存在。白色儿童的5年生存率（95%置信区间）为85.0%（83.6-86.2），亚裔儿童为81.4%（78.3-84.0），西班牙裔儿童为79.0%（77.8-80.2），黑人儿童为74.4%（69.4-78.8）。在多变量校正模型中，与白色儿童相比，黑人儿童的死亡风险增加了57%，西班牙裔儿童增加了38%，亚洲儿童增加了33%。居住在最低的SES社区在诊断的患者死亡的风险增加了39%，相对于那些生活在较高的SES neighborhoods.ConclusionDespite生存显着改善，非白人儿童和儿童居住在低SES社区经历了更糟糕的生存，即使调整潜在的混杂因素。我们的研究结果强调了需要捕获有关疾病生物学，治疗和治疗依从性的特定信息，以更好地了解少数和低SES组生存率较低的预测因素。儿科血液癌症2015;62：1819-1825。(c)2015 Wiley Periodicals，Inc.
BackgroundDespite advances in treatment, survival from acute lymphoblastic leukemia (ALL) remains lower among non-White children than White children in the US. We investigated the association of race/ethnicity and socioeconomic status (SES) with survival.ProceduresWe analyzed 9,295 Californian children (3,251 Whites, 4,890 Hispanics, 796 Asians, and 358 Blacks) aged 19 years diagnosed with a first primary ALL during 1988-2011. We used the Kaplan-Meier method to estimate survival at 1, 5, and 10 years after diagnosis for three calendar periods. Hazard ratios of death for race/ethnicity, SES, and clinical factors were estimated by Cox regression models.ResultsMedian follow-up time was 7.4 years (range 0-25 years). Over time, survival after ALL improved steadily, but inequalities persisted across races/ethnicities. Five-year survival (95% confidence interval) was 85.0% (83.6-86.2) for White, 81.4% (78.3-84.0) for Asian, 79.0% (77.8-80.2) for Hispanic, and 74.4% (69.4-78.8) for Black children. In multivariable-adjusted models, the hazard of death was increased by 57% among Black, 38% among Hispanic, and 33% among Asian children compared with White children. Patients residing in the lowest SES neighborhoods at diagnosis had a 39% increased risk of death relative to those living in higher SES neighborhoods.ConclusionDespite significant improvements in survival, non-White children and children residing in low SES neighborhoods experienced worse survival even after adjusting for potential confounders. Our findings highlight the need to capture specific information on disease biology, treatment, and treatment adherence to better understand the predictors of lower survival in minority and low SES groups. Pediatr Blood Cancer 2015;62:1819-1825. (c) 2015 Wiley Periodicals, Inc.