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Survival variability by race and ethnicity in childhood acute lymphoblastic leukemia
Nina S Kadan-Lottick1, Kirsten K Ness, Smita Bhatia
1Division of Pediatric Hematology/Oncology, Yale University, New Haven, Conn, USA.
Insights
Racial and ethnic disparities in childhood acute lymphoblastic leukemia (ALL) survival persist. Black, Hispanic, and Native American children face worse outcomes than white and Asian children, necessitating further investigation into contributing factors.
Area of Science:
- Pediatric Oncology
- Epidemiology
- Health Disparities
Background:
- The impact of race/ethnicity on pediatric acute lymphoblastic leukemia (ALL) survival remains debated.
- Some studies indicate poorer survival for minority children, while others suggest equivalent outcomes in modern treatment eras.
Purpose of the Study:
- To conduct a large-scale, population-based analysis of the relationship between race/ethnicity and survival in children with ALL in the United States.
- To examine survival trends across different racial and ethnic groups within distinct treatment periods.
Main Methods:
- Analysis of 4952 incident ALL cases in individuals aged 19 years or younger, diagnosed between 1973 and 1999.
- Utilized data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.
- Employed Kaplan-Meier curves and Cox regression, adjusting for treatment era, age at diagnosis, and sex.
Main Results:
- Overall 5-year survival improved across successive treatment eras, yet racial/ethnic disparities persisted.
- In the 1990-1999 era, 5-year survival rates were: White (84%), Asian/Pacific Islander (81%), Black (75%), American Indian/Alaskan Native (72%), and Hispanic (72%).
- Adjusted analyses revealed significantly higher hazard ratios for mortality among Black (1.50), Hispanic (1.83), and American Indian/Alaskan Native (1.90) children compared to White children.
Conclusions:
- Significant survival disadvantages exist for Black, Hispanic, and American Indian/Alaskan Native children diagnosed with ALL compared to White and Asian/Pacific Islander children.
- These disparities are evident even within the contemporary treatment era.
- Further research is crucial to identify the underlying social, biological, and pharmacokinetic factors contributing to these outcome differences.
Context:
The role of race/ethnicity in survival of children with acute lymphoblastic leukemia (ALL) is unclear, with some studies reporting poorer survival among minority children and others reporting equivalent survival across race/ethnicity in the modern, risk-stratified treatment era.
Objective:
To investigate the relation between race/ethnicity and survival in a large, population-based analysis of incident ALL cases in the United States. DESIGN, POPULATION, AND SETTING: This study included 4952 individuals diagnosed with ALL between 1973 and 1999 at age 19 years or younger. ALL cases were identified from 9 population-based registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results program.
Main Outcome Measures:
Survival probabilities were compared among white, black, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Native children. Kaplan-Meier curves and proportional hazard ratios from Cox regression analysis were calculated, accounting for treatment era (1973-1982, 1983-1989, and 1990-1999), age at diagnosis (<1, 1-9, and 10-19 years), and sex.
Results:
Although overall 5-year survival probabilities improved with each successive treatment era, differences according to race/ethnicity persisted. For 1990-1999, 5-year survival was 84% for white children, 81% for Asian/Pacific Islander children, 75% for black children, and 72% for both American Indian/Alaskan Native children and Hispanic children. The largest difference by race/ethnicity was observed among children diagnosed between ages 1 and 9 years. Compared with white children, after adjusting for treatment era, age at diagnosis, and sex, children of black, Hispanic, and American Indian/Alaskan Native descent had hazard ratios of 1.50 (95% CI, 1.0-2.2; P =.03), 1.83 (95% CI, 1.4-2.4; P<.001), and 1.90 (95% CI, 0.8-4.6; P =.16).
Conclusions:
Black, Hispanic, and American Indian/Alaskan Native children with ALL have worse survival than white and Asian/Pacific Islander children, even in the contemporary treatment era. Future work must delineate the social and biological factors, including any differences in pharmacokinetics associated with chemotherapeutic agents, that account for disparities in outcome.
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