Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens.
Ann Oncol. 2015 Mar;26(3):589-97. doi: 10.1093/annonc/mdu572. Epub 2014 Dec 19.
Despite advancements in the treatment of childhood leukemia, socioeconomic status (SES) may potentially affect disease prognosis. This study aims to evaluate whether SES is associated with survival from childhood leukemia.
The US National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) 1973-2010 data were analyzed; thereafter, results were meta-analyzed along with those from survival (cohort) studies examining the association between SES indices and survival from childhood leukemia (end-of-search date: 31 March 2014). Random-effects models were used to calculate pooled effect estimates (relative risks, RRs); meta-regression was also used.
We included 29 studies yielding 28 804 acute lymphoblastic leukemia (ALL), 3208 acute myeloblastic leukemia (AML) and 27 650 'any' leukemia (denoting joint reporting of all subtypes) cases. According to individual-level composite SES indices, children from low SES suffered from nearly twofold higher death rates from ALL (pooled RR: 1.83, 95% confidence interval 1.00-3.34, based on four study arms); likewise, death RRs derived from an array of lower area-level SES indices ranged between 1.17 and 1.33 (based on 11 study arms). Importantly, the survival gap between higher and lower SES seemed wider in the United States, with considerably (by 20%-82%) increased RRs for death from ALL in lower SES. Regarding AML, poorer survival was evident only when area-level SES indices were used. Lastly, remoteness indices were not associated with survival from childhood leukemia.
Children with lower SES suffering childhood leukemia do not seem to equally enjoy the impressive recent survival gains. Special health policy strategies and increased awareness of health providers might minimize the effects of socioeconomic disparities.
尽管儿童白血病的治疗取得了进展，但社会经济地位（SES）可能会影响疾病的预后。本研究旨在评估 SES 是否与儿童白血病的生存相关。
分析了美国国家癌症研究所监测、流行病学和结果计划（SEER）1973-2010 年的数据；此后，对这些结果进行了荟萃分析，并与 31 项生存（队列）研究的结果进行了荟萃分析，这些研究检查了 SES 指数与儿童白血病生存之间的关系（检索截止日期：2014 年 3 月 31 日）。使用随机效应模型计算汇总效应估计值（相对风险，RR）；还进行了元回归分析。
共纳入 29 项研究，包括 28804 例急性淋巴细胞白血病（ALL）、3208 例急性髓细胞白血病（AML）和 27650 例“任何”白血病（表示所有亚型的联合报告）病例。根据个体层面的综合 SES 指数，来自低 SES 的儿童 ALL 死亡率几乎高出两倍（汇总 RR：1.83，95%置信区间 1.00-3.34，基于四个研究组）；同样，来自一系列较低的区域 SES 指数的死亡率 RR 范围在 1.17 到 1.33 之间（基于 11 个研究组）。重要的是，美国高 SES 和低 SES 之间的生存差距似乎更大，低 SES 组 ALL 死亡率的 RR 增加了 20%-82%。关于 AML，只有使用区域 SES 指数时才显示出较差的生存情况。最后，偏远地区指数与儿童白血病的生存无关。
患有儿童白血病的 SES 较低的儿童似乎无法平等地享受最近令人印象深刻的生存获益。特殊的卫生政策策略和提高卫生保健提供者的认识可能会最大限度地减少社会经济差异的影响。
