In-hospital Mortality and Racial Disparity in Children and Adolescents With Acute Myeloid Leukemia: A
Maria I Castellanos1, Deepa Dongarwar2, Rachelle Wanser2
1Section of Pediatric Hematology/Oncology, Department of Pediatrics.
Insights
Non-Hispanic Black children with acute myeloid leukemia (AML) face higher in-hospital mortality risks. This disparity is particularly pronounced in those undergoing hematopoietic stem cell transplant, necessitating further research into underlying causes.
Area of Science:
- Pediatric Oncology
- Health Disparities Research
- Epidemiology
Background:
- Survival disparities in childhood acute myeloid leukemia (AML) are known but understudied.
- Factors predicting in-hospital mortality and racial/ethnic disparities in childhood AML require further investigation.
Purpose of the Study:
- To investigate factors associated with the risk of in-hospital death among childhood AML hospitalizations.
- To analyze racial/ethnic disparities in in-hospital mortality for pediatric AML patients.
Main Methods:
- Retrospective study utilizing the National Inpatient Sample (NIS) database from 2003 to 2017.
- Inclusion of 71,050 hospitalizations of children diagnosed with AML.
- Application of survey logistic regression models to assess associations between patient/hospital characteristics and in-hospital mortality.
Main Results:
- Non-Hispanic (NH) Black children exhibited a higher risk of in-hospital mortality compared to NH White children (aOR: 1.41, P<0.02).
- NH Black patients who received hematopoietic stem cell transplant (HSCT) had the highest mortality risk (aOR: 5.88, P<0.001) versus NH Black children without HSCT.
- Findings confirm a disproportionately higher likelihood of in-hospital mortality for NH Black children with AML.
Conclusions:
- NH Black children with AML experience significantly higher in-hospital mortality rates than their NH White counterparts.
- Hematopoietic stem cell transplant in NH Black pediatric AML patients is associated with a substantially increased mortality risk.
- Further research is crucial to understand the etiology of these observed racial/ethnic disparities in childhood AML outcomes.
Abstract:
Survival disparities in children and adolescents with acute myeloid leukemia (AML) are documented, however, the etiology of these disparities is understudied. Few studies have evaluated factors that predict in-hospital mortality in childhood AML and racial/ethnic disparities associated with in-hospital death. Our study aimed to investigate factors associated with the risk of in-hospital death among childhood AML hospitalizations. We conducted a retrospective study of childhood AML hospitalizations using the National Inpatient Sample (NIS) from 2003 to 2017. We estimated incidences of in-hospital death among AML hospitalizations. We performed survey logistic regression models to measure the association between patient and hospital characteristics and in-hospital mortality. We identified 71,050 hospitalizations of children with AML. Compared with non-Hispanic (NH) whites, NH-black children had a higher risk of in-hospital mortality (adjusted odds ratio: 1.41, 95% confidence interval: 1.06-1.87, P<0.02). Further, NH-black patients with hematopoietic stem cell transplant experienced the highest risk of mortality (adjusted odds ratio: 5.88, 95% confidence interval: 3.13-11.06, P<0.001) as compared with NH-black children who did not receive hematopoietic stem cell transplant. Our findings highlight that NH-black children with AML continue to experience a disproportionately higher likelihood of in-hospital mortality when compared with their NH-white counterparts. Further studies are needed to delineate the etiology of these disparities.
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