Effects of Poverty and Race on Outcomes in Acute Myeloid Leukemia
Effects of Poverty and Race on Outcomes in Acute Myeloid Leukemia
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DOI：
10.1097/coc.0b013e3181dea934
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发表时间：
2011-06-01
影响因子：
2.6
通讯作者：
Cheung, Michael C.
中科院分区：
文献类型：
--
作者：
Byrne, Margaret M.;Halman, L. Jill;Cheung, Michael C.
目的：确定患者种族、民族和贫困程度如何影响急性髓性白血病（AML）的治疗和生存率。方法：查询1998-2002年佛罗里达癌症登记处和州住院和门诊医院数据的链接数据库。使用单变量和多变量分析方法探讨人口统计学和治疗特征对生存率的影响。结果：共确定了4659例AML患者。超过50%的AML患者年龄在70岁或以上。非裔美国人（AA）患者的诊断年龄明显低于白人（P < 0.001）。在多变量分析中，年龄超过50岁是AML生存率较差的独立预测因素（风险比竖线HR竖线：1.60、2.15、3.04和3.62，十年队列，所有P < 0.001），AA种族（HR：1.27，P < 0.001），曾经或现在吸烟者（HR：1.13，P = 0.004和HR：1.28，P < 0.001），居住在贫困程度最高的地区（HR：1.15，P = 0.007），仅由医疗补助覆盖（HR：1.23，P = 0.014）。未观察到与性别或种族相关的结局差异。接受化疗与生存率的改善密切相关（HR：0.59，P < 0.001）。当只有那些患者谁收到，似乎对治疗作出反应，AA继续表现出比Whites.Conclusions更糟糕的结果：AML不成比例地影响老年人。AA患者和来自贫困社区的AML患者的生存率明显更差。需要采取干预措施，为这些患者提供早期诊断，并改善总体结局，以解决这些差异。
Objectives: To determine how patient race, ethnicity, and degree of poverty affect treatment and survival for acute myeloid leukemia (AML).Methods: A linked database of the Florida cancer registry and State inpatient and outpatient hospital data for 1998-2002 was queried. Effects of demographic and treatment characteristics on survival were explored using univariate and multivariate analyses methods.Results: A total of 4659 patients with AML were identified. Over 50% of patients with AML were 70 years of age or older. African American (AA) patients were diagnosed at significantly younger ages than were whites (P < 0.001). In multivariate analysis, independent predictors of worse survival in AML were aged over 50 (hazard ratios vertical bar HRs vertical bar: 1.60, 2.15, 3.04, and 3.62 over the decade-cohorts, all P < 0.001), AA race (HR: 1.27, P < 0.001), being a former or current user of tobacco (HR: 1.13, P = 0.004 and HR: 1.28, P < 0.001, respectively), residing in an area with the highest poverty level (HR: 1.15, P = 0.007), and being covered only by Medicaid (HR: 1.23, P = 0.014). No differences in outcomes were observed related to gender or ethnicity. Receipt of chemotherapy was strongly associated with improved survival (HR: 0.59, P < 0.001). When only those patients who received and appeared to respond to treatment are included, AAs continued to demonstrate a worse outcome than Whites.Conclusions: AML disproportionately affects the elderly. AA patients and patients from poorer communities with AML have significantly worse survival. Interventions to provide earlier diagnosis in these patients as well as to improve overall outcomes are needed to address these disparities.