精准医学与健康差异：以小儿急性淋巴细胞白血病为例。
Precision medicine and health disparities: The case of pediatric acute lymphoblastic leukemia.
机构信息
Department of Bioethics and Humanities, University of Washington, Seattle, WA.
Department of Pharmaceutics, University of Washington, Seattle, WA.
出版信息
Nurs Outlook. 2019 Jul-Aug;67(4):331-336. doi: 10.1016/j.outlook.2019.05.003. Epub 2019 May 14.
BACKGROUND
Precision medicine has uncertain potential to address population health disparities.
PURPOSE
Case study of disparities in pediatric acute lymphoblastic leukemia (ALL).
METHOD
Literature-based evaluation of ALL in African American (AA) and European American (EA) children.
FINDINGS
AA children have a lower incidence of ALL than EA children, experience higher relapse rates, and are more likely to be diagnosed with poor prognostic indicators. Environmental risk exposures for ALL have small effect sizes; data are insufficient to determine their contribution to differences in incidence and prognosis. Differences in prevalence of gene variants associated with treatment response contribute to higher relapse rates in AA children. However, higher relapse rates were not seen in a care setting that eliminated out of pocket costs, used risk-directed therapy, and included rigorous case management.
DISCUSSION
Unequal access to effective treatment contributes to ALL disparities. Precision medicine can help to define effective treatment for diverse patient populations.
背景
精准医学在解决人口健康差异方面具有不确定的潜力。
目的
以小儿急性淋巴细胞白血病 (ALL) 为例，研究差异。
方法
基于文献评估非裔美国儿童 (AA) 和欧洲裔美国儿童 (EA) 的 ALL。
发现
AA 儿童 ALL 的发病率低于 EA 儿童，复发率较高，且更有可能被诊断为预后不良的指标。ALL 的环境风险暴露的效应量较小；数据不足以确定其对发病率和预后差异的贡献。与治疗反应相关的基因变异的流行率差异导致 AA 儿童的复发率较高。然而，在一个消除自付费用、采用风险导向治疗并包括严格病例管理的护理环境中，并未观察到较高的复发率。
讨论
获得有效治疗的机会不平等导致了 ALL 差异。精准医学可以帮助为不同的患者群体确定有效的治疗方法。
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