Racial/ethnic and socioeconomic disparities in survival among children with acute lymphoblastic leukemia in California, 1988-2011: A population-based observational study

Abstract

Background Despite 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. Procedures We 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. Results Median 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. Conclusion Despite 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. © 2015 Wiley Periodicals, Inc.

Predictors of early death and survival among children, adolescents and young adults with acute myeloid leukaemia in California, 1988–2011: a population‐based study

“…We found worse survival among black patients than white patients, consistent with previous studies of AML and acute lymphoblastic leukaemia (ALL) (Abrahão, et al 2015b; Aplenc, et al 2006; Byrne, et al 2011; Patel, et al 2015b; Pulte, et al 2012; Pulte, et al 2013; Rubnitz, et al 2007; Sekeres, et al 2004). Results from several clinical trials at a single institution in the US showed survival in black children with AML to be similar to that in white children (Rubnitz, et al 2007).…”

“…This differs from the results of 2 consecutive clinical trials by the Children’s Oncology Group (patients aged 0 to 21 years) (Aplenc, et al 2006), but is consistent with the population-based study mentioned above (Patel, et al 2015a) that found survival among Hispanics to be similar to that among white patients after adjustment for age (all ages included), and with paediatric clinical trials that showed favourable outcomes among Hispanic patients with AML (Rubnitz, et al 2007). These observations contrast with the worse survival observed among Hispanic children and adolescents with ALL in the US (Abrahão, et al 2015b; Goggins and Lo 2012; Lim, et al 2014; Pulte, et al 2013), and suggest that unfavourable biological characteristics are associated with survival after ALL, (Lim, et al 2014) but may not contribute, to the same extent, to the worse outcomes after AML. In fact, clinical trials have shown favourable cytogenetic characteristics among Hispanic children with AML (Rubnitz, et al 2007).…”

The Association of Race With Childhood Uveitis

“…This could be secondary to a delay in referral and diagnosis or due to underlying genetic differences in relation to prevalence and outcome. Several studies have shown racial and ethnic disparities in healthcare access and outcomes in children 37,38 . Most studies in non-Hispanic White children with JIA-associated uveitis show associations with the HLA-DRB1 allele, and one study highlighted the association of HLA-DR8, but not HLA-DR5, with chronic non-granulomatous anterior uveitis in African Americans 39 .…”

Exposure to ambient dichloromethane in pregnancy and infancy from industrial sources and childhood cancers in California

“…As this was a record-based study, we did not seek informed consent from individual subjects. The demographic and gestational characteristics of cases and controls have been previously reported (Abrahao et al, 2015; Hall et al, 2016; Heck et al, 2012; Heck et al, 2013b; Heck et al, 2014, 2015; Heck et al, 2013c; Shrestha et al, 2013). …”