Walsh Alexandra, Chewning Joseph, Li Xuelin, Dai Chen, Whelan Kimberly, Madan-Swain Avi, Waterbor John, Baskin Monica L, Goldman Frederick D
Department of Pediatric Hematology and Oncology, Children's Specialty Center of Nevada, Las Vegas, Nevada.
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Pediatr Blood Cancer. 2017 Feb;64(2):267-274. doi: 10.1002/pbc.26222. Epub 2016 Sep 21.
While significant improvements have been made for children with acute lymphoblastic leukemia (ALL) in the United States over the past 20 years, black patients continue to have inferior outcomes. The full impact of socioeconomic variables on outcomes in this minority population is not entirely understood.
Disease characteristics, demographic, and socioeconomic status (SES) variables were collected on black (n = 44) and white (n = 178) patients diagnosed at the University of Alabama at Birmingham. Cox proportional hazard regression was used to evaluate the influence of SES and insurance status on survival.
As a cohort, 5-year overall survival (OS) was 87% (82-91%), with a median follow-up of 99 months. In univariable analysis, black race was not significantly associated with a higher risk of death or relapse and death. White and black patients with standard-risk leukemia had excellent outcomes, with 97% (91-99%) and 96% (75-99%) 5-year OS, respectively. In contrast, for high-risk disease, white patients had a statistically significant improved 5-year OS rates compared with black patients (79% [68-87%] vs. 52% [28-72%]). Black children were more likely to have public insurance, and, in multivariable analysis, this was associated with a trend toward an improved outcome. Black patients also had poorer census tract-level SES parameters, but these variables were not associated with survival.
Our study demonstrates significantly inferior outcomes for black children with high-risk leukemia. These outcome disparities were not related to SES variables, including poverty or private insurance coverage, suggesting the involvement of other factors and highlighting the need for a prospective investigative analysis.
在过去20年里，美国急性淋巴细胞白血病（ALL）患儿的治疗取得了显著进展，但黑人患者的预后仍然较差。社会经济变量对这一少数族裔人群预后的全面影响尚未完全了解。
收集了阿拉巴马大学伯明翰分校诊断的黑人（n = 44）和白人（n = 178）患者的疾病特征、人口统计学和社会经济地位（SES）变量。采用Cox比例风险回归评估SES和保险状况对生存的影响。
作为一个队列，5年总生存率（OS）为87%（82 - 91%），中位随访时间为99个月。在单变量分析中，黑人种族与更高的死亡或复发及死亡风险无显著关联。标准风险白血病的白人和黑人患者预后良好，5年OS分别为97%（91 - 99%）和96%（75 - 99%）。相比之下，对于高危疾病，白人患者的5年OS率与黑人患者相比有统计学显著改善（79% [68 - 87%] 对52% [28 - 72%]）。黑人儿童更有可能拥有公共保险，在多变量分析中，这与预后改善的趋势相关。黑人患者的人口普查区层面的SES参数也较差，但这些变量与生存无关。
我们的研究表明，高危白血病黑人儿童的预后明显较差。这些预后差异与SES变量无关，包括贫困或私人保险覆盖情况，这表明还有其他因素参与其中，并突出了进行前瞻性调查分析的必要性。
