Infection‐related mortality in Hispanic and non‐Hispanic children with cancer

Smits-Seemann, Rochelle R.; Pettit, Jacob; Li, Hongyan; Kirchhoff, Anne C.; Fluchel, Mark

doi:10.1002/pbc.26502

Cited by 15 publications

(11 citation statements)

References 85 publications

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“…Respiratory infections could potentially be a significant contributor because we observed a >2‐fold increase in the risk of ED visits for respiratory infections among cases who were Hisapnic/other. This supports the idea that poorly controlled or more severe infections play a significant role in the observed higher infection‐related mortality …”

Section: Discussionsupporting

confidence: 83%

Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Ramsay

Fluchel

et al. 2018

Cancer

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BACKGROUND Children and adolescents and young adults (AYAs) with cancer often experience severe respiratory morbidity and mortality from the therapies used to treat their cancers. Few studies have examined respiratory outcomes among this population using emergency department (ED) visits as an objective measure of respiratory health. METHODS ED visits for respiratory conditions were identified for children and AYAs diagnosed with cancer, 0‐25 years of age, from 1997 through 2012 (2535 cases) and compared with a birthdate‐matched and sex‐matched cohort without cancer drawn from the general population (7605 controls). Negative binomial regression with robust standard errors was used to estimate incidence rates, rate ratios (RRs), and 95% confidence intervals for primary respiratory ED visits, combined and by diagnosis (asthma, respiratory disease, and respiratory infection) from 1997 through 2015. Analyses were performed for new cases (0 to <5 years from diagnosis) and survivors (5‐18 years from diagnosis). RESULTS Subjects were followed for an average of 8 years (range, 0‐18 years). Relative to the comparison cohort, cancer cases had higher incidence rates for all types of respiratory ED visits over both follow‐up times. New cases had significantly higher RRs for any respiratory condition (RR, 4.14), respiratory disease (RR, 4.62), and respiratory infection (RR, 4.74). Among survivors, the RRs for any respiratory condition (RR, 2.00) and respiratory infection (RR, 2.10) were significantly elevated, although the magnitude tended to decline in survivorship. Demographic and clinical risk factors found to be associated with respiratory ED visits included Hispanic/other race/ethnicity, male sex, exposure to chemotherapy, diagnosis at a younger age, and a diagnosis of leukemia. CONCLUSIONS The results of the current study demonstrated that children and AYAs with cancer face an increased burden of respiratory complications compared with a comparison cohort without cancer from diagnosis through survivorship.

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Section: Discussionsupporting

confidence: 83%

Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Ramsay

Fluchel

et al. 2018

Cancer

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“…A previous study of this cohort reports a higher risk for mortality due to infection among Hispanic cancer survivors [54]. In the current report, we found a significant association between PM 2.5 and respiratory infection events from a combined group of Hispanic/Other ethnicity survivors, the majority of whom were Hispanic.…”

Section: Discussionsupporting

confidence: 67%

Fine Particulate Matter and Respiratory Healthcare Encounters among Survivors of Childhood Cancers

Hanson

Ramsay

et al. 2019

IJERPH

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Some chemotherapies that treat childhood cancers have pulmonary-toxic properties that increase risk for adverse respiratory-health outcomes. PM2.5 causes similar outcomes but its effect among pulmonary compromised cancer survivors is unknown. This case-crossover study identified the PM2.5-associated odds for primary-respiratory hospitalizations and emergency department visits among childhood cancer survivors in Utah. We compared risk among chemotherapy-treated survivors to a cancer-free sample. We calculated 3-day-average PM2.5 by ZIP code and county for event and control days. Conditional logistic regression estimated odds ratios. Models were stratified by cause of admission (infection, respiratory disease, asthma), previous chemotherapy, National Ambient Air Quality Standard (NAAQS), and other variables. Results are presented per 10 µg/m3 of PM2.5. 90% of events occurred at 3-day PM2.5 averages <35.4 µg/m3, the NAAQS 24-h standard. For survivors, PM2.5 was associated with respiratory hospitalizations (OR = 1.84, 95% CI = 1.13–3.00) and hospitalizations from respiratory infection (OR = 2.09, 95% CI = 1.06–4.14). Among chemotherapy-treated survivors, the PM2.5-associated odds of respiratory hospitalization (OR = 2.03, 95% CI = 1.14–3.61) were significantly higher than the cancer-free sample (OR = 0.84, 95% CI = 0.57–1.25). This is the first study to report significant associations between PM2.5 and respiratory healthcare encounters in childhood cancer survivors. Chemotherapy-treated survivors displayed the highest odds of hospitalization due to PM2.5 exposure and their risk is significantly higher than a cancer-free sample.

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“…Our finding is consistent with prior research of serious infection during childhood cancer treatment. Smits-Seemann et al (2017) determined that, when compared with non-Hispanic White children, Hispanic children with cancer were more likely to require transfer to an intensive care unit for management of infection. Additionally, Hispanic children diagnosed with AML and treated between 1996 and 2000 in a clinical trial conducted by the Children's Oncology Group had a significantly higher risk of death from infection compared with White children (Aplenc et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

“…The therapy required for the successful treatment of malignancies leaves all children vulnerable to infection (Hakim & Gaur, 2011;Kline, 2011). Yet, despite universal exposure to immunosuppressive therapy, non-White children receiving cancer treatment develop invasive bacterial infections at higher rates than White children (Doganis et al, 2013;Hakim et al, 2010;Smits-Seemann et al, 2017). A retrospective study by Doganis et al (2013) found that African American children hospitalized with treatment-related neutropenia were nearly two times more likely to develop a blood stream infection than White children.…”

Section: Introductionmentioning

confidence: 99%

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

Savage¹,

Thomas‐Hawkins²,

Cole

et al. 2020

J Pediatr Oncol Nurs

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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.

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Infection‐related mortality in Hispanic and non‐Hispanic children with cancer

Abstract: Hispanic pediatric cancer patients were more likely to have an infection-related death and higher rates of ICU admissions than non-Hispanic patients. Infection may be an overlooked contributor to poorer outcomes among Hispanic patients.

Cited by 15 publications

References 85 publications

Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Fine Particulate Matter and Respiratory Healthcare Encounters among Survivors of Childhood Cancers

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

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