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Neighborhood Factors and Treatment Outcomes in Pediatric Acute Lymphoblastic Leukemia: A REDIAL Consortium Report
Rutu Rathod1,2,3, Amy E Hughes3,4, Pagna Sok5
1Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Insights
Neighborhood socioeconomic status and Hispanic enclave residence did not impact pediatric acute lymphoblastic leukemia (ALL) treatment outcomes in Texas. This study found no independent association after adjusting for clinical factors, suggesting other influences may affect disparities.
Area of Science:
- Pediatric Oncology
- Health Disparities Research
- Social Determinants of Health
Background:
- Acute lymphoblastic leukemia (ALL) exhibits persistent outcome disparities in socioeconomically disadvantaged and Hispanic children.
- The influence of neighborhood socioeconomic status (nSES) and Hispanic enclave residence on pediatric ALL outcomes remains unclear.
Purpose of the Study:
- To examine the associations between nSES, Hispanic enclave residence, and treatment outcomes in pediatric ALL.
- To determine if neighborhood factors independently affect outcomes after accounting for clinical and demographic variables.
Main Methods:
- Analysis of 1,348 children (0-24 years) diagnosed with ALL between 2005-2017 in Texas.
- Utilized U.S. Census and ACS data to classify census tracts by nSES and Hispanic enclave status.
- Employed multivariable logistic and Cox regression models to assess outcomes including end-of-induction minimal residual disease, relapse, event-free survival, and overall survival, adjusting for clinical covariates.
Main Results:
- Neither Hispanic enclave residence nor low nSES were independently associated with end-of-induction minimal residual disease positivity, relapse, event-free survival, or overall survival.
- Unadjusted analyses showed a trend towards poorer event-free survival in low nSES areas, but this difference attenuated after adjustment for clinical factors.
- The study found no significant independent association between neighborhood socioeconomic disadvantage or Hispanic enclave residence and pediatric ALL treatment outcomes.
Conclusions:
- Neighborhood socioeconomic status and Hispanic enclave residence were not independently associated with treatment outcomes in pediatric ALL patients in this cohort.
- Findings suggest that other social determinants or neighborhood influences may play a role in disease characteristics, survivorship, and late effects.
- Further research is needed to explore these alternative factors contributing to health disparities in pediatric ALL.
Abstract:
Acute lymphoblastic leukemia (ALL) shows persistent outcome disparities among socioeconomically disadvantaged and Hispanic children. Neighborhood socioeconomic status (nSES) and residence in Hispanic enclaves may contribute to these disparities, yet their impact on pediatric ALL is unclear. We examined associations of nSES and Hispanic enclave residence with ALL treatment outcomes. We analyzed children (0-24 years) diagnosed with ALL between 2005 and 2017 and treated at REducing Disparities In Acute Leukemia (REDIAL) Consortium centers in Texas. Census-tract nSES (Yost) and Hispanic enclave indices were computed from US Census and American Community Survey (ACS) data, classifying tracts into low/high nSES and enclave/no enclave residence. Outcomes included end-of-induction (EOI) minimal residual disease (MRD) positivity (MRD ≥ 0.01%), relapse, event-free survival (EFS), and overall survival (OS). Associations were evaluated using multivariable logistic and Cox regression models adjusting for sex, age at diagnosis, race/ethnicity, EOI MRD, cytogenetic features, National Cancer Institute (NCI) risk group at diagnosis, ALL immunophenotype, and treating institutions. Among 1,348 patients, 41% resided in low-nSES tracts and 42% in Hispanic enclaves. Neither enclave residence nor low nSES was associated with EOI MRD positivity; similar null associations were observed for relapse, EFS, and OS. Although unadjusted analyses indicated slightly poorer 5-year EFS for low-nSES areas (81% vs. 85%, P = 0.04), this difference attenuated after adjustment. In this large, multicenter, and diverse cohort of children with ALL, neighborhood socioeconomic disadvantage and Hispanic enclave residence were not independently associated with treatment outcomes after accounting for clinical and cytogenetic features. Future studies should examine other social determinants and neighborhood influences on disease characteristics, survivorship, and late effects.
Significance:
In this multicenter study, neither neighborhood socioeconomic disadvantage nor residence in a Hispanic/Latino enclave was associated with inferior outcomes among children with ALL after controlling for clinical and cytogenetic disease features. Disparities affecting economically disadvantaged or minoritized populations may be mediated by other factors.
