Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS BCM307, Houston, TX, 77030, USA.
Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA.
J Cancer Surviv. 2021 Oct;15(5):767-775. doi: 10.1007/s11764-020-00968-7. Epub 2020 Nov 23.
Area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, has been linked to metabolic outcomes in the general population but has received limited attention in survivors of childhood acute lymphoblastic leukemia (ALL), a population with high rates of overweight and obesity.
We retrospectively reviewed heights and weights of ≥ 5 year survivors of pediatric ALL (diagnosed 1990-2013). Residential addresses were geocoded using ArcGIS to assign quartiles of ADI, a composite of 17 measures of poverty, housing, employment, and education, with higher quartiles reflecting greater deprivation. Odds ratios (OR) and 95% confidence intervals (CI) for the association between ADI quartiles and overweight/obesity or obesity alone were calculated with logistic regression.
On average, participants (n = 454, 50.4% male, 45.2% Hispanic) were age 5.5 years at diagnosis and 17.4 years at follow-up. At follow-up, 26.4% were overweight and 24.4% obese. Compared to the lowest ADI quartile, survivors in the highest quartile were more likely to be overweight/obese at follow-up (OR = 2.33, 95% CI: 1.23-4.44) after adjusting for race/ethnicity, sex, age at diagnosis, and age at follow-up. The highest ADI quartile remained significantly associated with obesity (OR = 5.28, 95% CI: 1.79-15.54) after accounting for weight status at diagnosis.
This study provides novel insights into possible social determinants of health inequalities among survivors of childhood ALL by reporting a significant association between neighborhood deprivation and overweight/obesity.
Survivors of childhood ALL residing in neighborhood with greater socioeconomic disadvantage may be at increased risk of overweight and obesity and candidates for targeted interventions.
居住环境剥夺指数（ADI）是衡量邻里社会经济劣势的一个指标，它与普通人群的代谢结果有关，但在儿童急性淋巴细胞白血病（ALL）幸存者中受到的关注有限，ALL 幸存者中有很高的超重和肥胖率。
我们回顾性地分析了 1990 年至 2013 年间诊断出的至少 5 年的儿科 ALL 幸存者的身高和体重。使用 ArcGIS 对居住地址进行地理编码，以分配 ADI 的四分位数，ADI 是贫困、住房、就业和教育等 17 项指标的综合指数，四分位数越高反映剥夺程度越高。使用逻辑回归计算 ADI 四分位数与超重/肥胖或单纯肥胖之间的关联的优势比（OR）和 95%置信区间（CI）。
平均而言，参与者（n=454，50.4%为男性，45.2%为西班牙裔）在诊断时的年龄为 5.5 岁，在随访时的年龄为 17.4 岁。在随访时，26.4%超重，24.4%肥胖。与最低 ADI 四分位数相比，最高 ADI 四分位数的幸存者在随访时超重/肥胖的可能性更高（OR=2.33，95%CI：1.23-4.44），调整了种族/民族、性别、诊断时年龄和随访时年龄。在考虑到诊断时的体重状况后，最高 ADI 四分位数与肥胖仍显著相关（OR=5.28，95%CI：1.79-15.54）。
本研究通过报告邻里剥夺与超重/肥胖之间的显著关联，为儿童 ALL 幸存者中健康不平等的可能社会决定因素提供了新的见解。
居住在社会经济劣势较大的邻里的儿童 ALL 幸存者可能面临超重和肥胖的风险增加，是针对性干预的候选对象。
