Socioeconomic inequality in treatment of acute myeloid leukaemia (AML) in England, 2015-2022: A population-based study

The socioeconomic inequality in acute myeloid leukaemia (AML) survival may be driven by differential access to intensive chemotherapy (ICT). We aimed to quantify socioeconomic inequality in the receipt of ICT among patients with AML in England and identify its key drivers. We evaluated 10 495 patients with de novo AML identified in the national cancer registry of England (2015-2022) along with their area-deprivation status, as a measure of socioeconomic inequality, and treatment information based on linkage databases. We related prevalence of the ICT receipt to deprivation with multivariable-adjusted generalised regression and mixed-effects probit regression. Overall, 5190 patients (49%) received ICT. The patients in the most deprived area were 6.1% less likely to receive ICT than those in the least deprived area. The differences in the prevalence measures varied across the 125 administrative clusters of health service units. If all patients had access to ICT similar to the least deprived patients, 247 more patients would receive ICT. Of the deprivation effect, 94% was estimated to be attributable to the variability among administrative clusters. Despite universal healthcare coverage, socioeconomic inequality exists in AML treatment in England. The inequality may be driven by cluster-level variations such as institutional culture and resource capacity.