Sociodemographic disparities in chemotherapy and hematopoietic cell transplantation utilization among adult acute lymphoblastic and acute myeloid leukemia patients.
Sociodemographic disparities in chemotherapy and hematopoietic cell transplantation utilization among adult acute lymphoblastic and acute myeloid leukemia patients.
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DOI：
10.1371/journal.pone.0174760
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Wieduwilt MJ
中科院分区：
文献类型：
--
作者：
Jabo B;Morgan JW;Martinez ME;Ghamsary M;Wieduwilt MJ
确定急性淋巴细胞白血病 (ALL) 和急性髓性白血病 (AML) 化疗和造血细胞移植 (HCT) 治疗中的社会人口统计学差异，可能会提高服务不足人群的生存率。在这项研究中，我们将社区社会经济状况 (nSES)、婚姻状况和距移植中心的距离与之前研究的因素结合起来，对影响 ALL 和 AML 治疗的社会人口学因素进行全面分析。我们利用加州癌症登记处，对 2003 年至 2012 年 ≥15 岁的 ALL (n = 3,221) 或 AML (n = 10,029) 患者进行了一项回顾性、基于人群的研究。分析了年龄、性别、种族/族裔、婚姻状况、nSES 和距最近移植中心的距离对不接受治疗、单独化疗或化疗后 HCT 的影响。未治疗、单纯化疗或化疗后 HCT 的 ALL 患者和 AML 患者分别有 11%、75% 和 14% 和 36%、53% 和 11%。对于≥60 岁的 ALL 患者，HCT 利用率从 2005 年的 5% 增加到 2012 年的 9% (p = 0.03)。对于≥60岁的AML患者，从2005年到2012年，化疗利用率从39%增加到58%（p<0.001），HCT利用率从5%增加到9%（p<0.001）。协变量调整分析显示，ALL 和 AML 的化疗相对风险 (RR) 随着年龄的增加而降低（趋势 p <0.001）。相对于非西班牙裔白人，西班牙裔的 HCT 利用率较低 [ALL，RR = 0.80 (95% CI = 0.65–0.98)； AML，RR = 0.86 (95% CI = 0.75–0.99)]和非西班牙裔黑人患者[ALL，RR = 0.40 (95% CI = 0.18–0.89)； AML，RR = 0.60（95% CI = 0.44–0.83）]。与已婚患者相比，未婚患者接受化疗的 RR 较低 [ALL，RR = 0.96 (95% CI = 0.92–0.99)； AML，RR = 0.94 (95% CI = 0.90–0.98)] 或 HCT [ALL，RR = 0.58 (95% CI = 0.47–0.71)； AML，RR = 0.80（95% CI = 0.70–0.90）]。较低的 nSES 五分位数预示着 ALL 和 AML 的化疗和 HCT 利用率较低（趋势 p <0.001）。年龄较大、nSES 较低和未婚预示着 ALL 和 AML 患者化疗和 HCT 的利用率较低，而西班牙裔或黑人种族/族裔则预示着 HCT 率较低。解决这些差异可能会增加治疗服务不足的急性白血病人群的治疗利用率。
Identifying sociodemographic disparities in chemotherapy and hematopoietic cell transplantation (HCT) utilization for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) may improve survival for underserved populations. In this study, we incorporate neighborhood socioeconomic status (nSES), marital status, and distance from transplant center with previously studied factors to provide a comprehensive analysis of sociodemographic factors influencing treatments for ALL and AML. Using the California Cancer Registry, we performed a retrospective, population-based study of patients ≥15 years old with ALL (n = 3,221) or AML (n = 10,029) from 2003 through 2012. The effect of age, sex, race/ethnicity, marital status, nSES, and distance from nearest transplant center on receiving no treatment, chemotherapy alone, or chemotherapy then HCT was analyzed. No treatment, chemotherapy alone, or chemotherapy then HCT were received by 11%, 75%, and 14% of ALL patients and 36%, 53%, and 11% of AML patients, respectively. For ALL patients ≥60 years old, HCT utilization increased from 5% in 2005 to 9% in 2012 (p = 0.03). For AML patients ≥60 years old, chemotherapy utilization increased from 39% to 58% (p<0.001) and HCT utilization from 5% to 9% from 2005 to 2012 (p<0.001). Covariate-adjusted analysis revealed decreasing relative risk (RR) of chemotherapy with increasing age for both ALL and AML (trend p <0.001). Relative to non-Hispanic whites, lower HCT utilization occurred in Hispanic [ALL, RR = 0.80 (95% CI = 0.65–0.98); AML, RR = 0.86 (95% CI = 0.75–0.99)] and non-Hispanic black patients [ALL, RR = 0.40 (95% CI = 0.18–0.89); AML, RR = 0.60 (95% CI = 0.44–0.83)]. Compared to married patients, never married patients had a lower RR of receiving chemotherapy [ALL, RR = 0.96 (95% CI = 0.92–0.99); AML, RR = 0.94 (95% CI = 0.90–0.98)] or HCT [ALL, RR = 0.58 (95% CI = 0.47–0.71); AML, RR = 0.80 (95% CI = 0.70–0.90)]. Lower nSES quintiles predicted lower chemotherapy and HCT utilization for both ALL and AML (trend p <0.001). Older age, lower nSES, and being unmarried predicted lower utilization of chemotherapy and HCT among ALL and AML patients whereas having Hispanic or black race/ethnicity predicted lower rates of HCT. Addressing these disparities may increase utilization of curative therapies in underserved acute leukemia populations.