Increased Risk of Severe Sepsis in Hispanic Children Hospitalized With Acute Myeloid Leukemia

Abstract

The purpose of this study, a secondary analysis of a publicly available database, was to identify racial and ethnic disparities in the risk of severe sepsis facing children undergoing the intensive therapy necessary to treat acute myeloid leukemia (AML). The sample consisted of 1,913 hospitalizations of children, younger than 21 years, in the United States during the year 2016 with documentation of both AML and at least one infectious complication. Binary logistic regression models were used to examine the association between race/ethnicity and severe sepsis in children with AML and infection. We found that, after controlling for potential confounding variables, the odds of developing severe sepsis were significantly increased for Hispanic children compared with White children. There were no significant differences in the likelihood of the development of sepsis in Black, Asian, or other race children. The increased risk of severe sepsis for Hispanic children may contribute to the disparate rates of overall survival in this group. This inequitable rate of severe sepsis was evident despite the generally accepted practice of retaining children in the hospital throughout recovery of blood counts following AML therapy. Nurses are in a position to identify and eliminate modifiable risk factors contributing to this disparity.

Pediatric Oncology Nurse-Led Research and Evidence-Based Practice: Global Exemplars to Reduce Disparity

“…Even in HICs, important disparities in outcomes related to supportive care, typically aligned with nursing care, are present. For example, in the United States, Hispanic children with acute myelogenous leukemia have a greater risk of developing severe sepsis while hospitalized relative to white children (Savage et al, 2020). Additionally, data from the Surveillance, Epidemiology, and End Results (SEER) database over 10 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) indicated that overall, 5-year survival for children with retinoblastoma was significantly higher for non-Hispanic White children compared to Black children and Black children had a significantly higher rate of enucleation (Truong et al, 2015).…”

Fungal infections in pediatric patients with acute myeloid leukemia in a tertiary hospital

“…Little is known about IFD-related mortality rates in Latin America. However, it is known that in this region, there is a higher incidence of AML (35.5% of all acute leukemia cases in pediatric patients) compared to that in Caucasian populations (5-13% of all acute leukemia cases in pediatric patients) (6)(7)(8).…”

Race, Neighborhood Opportunity, and Life-Threatening Complications in Children With Cancer

“…2 There is evidence of racial disparities in the incidence and severity of life-threatening complications in children with cancer. [3][4][5][6][7] Based on their systematic review of the extant literature, Beltrami et al 8 concluded that social and cultural forces likely contribute to a complex causality for these racial disparities beyond biological differences alone. In a second review of the current literature published between 2009 and 2021, Tran et al 9 identified gaps in our understanding of the mechanisms underlying these persistent disparities, citing the absence of social and cultural factors at both the individual and community levels in the research of childhood cancer survivorship.…”

“…The overall findings of this study are consistent with previous reporting of racial and economic disparities in the clinical context of life-threatening complications experienced by children hospitalized with cancer. [3][4][5][6][7] Unlike previous research, this study considers the mediating effect of neighborhood opportunity taking into consideration potential pathways consequent to societal norms and policies that foster structural racial inequities. The rationale for choosing the COI as the mediating variable between race and adverse childhood cancer outcomes, in this case life-threatening complications, over other conventional measures of socioeconomic status is 2-fold.…”

“…Treatment-related complications with the potential to cause a rapid decline are most often due to exposure to chemotherapy, examples of which are bacteremia, encephalopathy, and hemorrhage 2 . There is evidence of racial disparities in the incidence and severity of life-threatening complications in children with cancer 3–7 . Based on their systematic review of the extant literature, Beltrami et al 8 concluded that social and cultural forces likely contribute to a complex causality for these racial disparities beyond biological differences alone.…”