Leukemia survival in children, adolescents, and young adults: influence of socioeconomic status and other demographic factors.
OBJECTIVE
In California, leukemia represents ~35, 5, and 2% of all cancers in children (aged 0-14), adolescents (15-29), and young adults (30-39), respectively. Poorer survival has been previously noted in individuals residing in lower socioeconomic status (SES) neighborhoods. We explored the relationship between SES and survival as modified by age and race/ethnicity using data from the California Cancer Registry.


METHODS
A total of 7,688 incident cases of first primary leukemia diagnosed during 1996-2005 in individuals aged 0-39 at diagnosis were included in this study. Univariate analyses of overall survival were conducted using the Kaplan-Meier method and multivariate survival analyses were performed using Cox proportional hazard regression to estimate hazard ratios.


RESULTS
Multivariate analyses showed that overall survival and lymphoid cancer-specific survival was reduced in those individuals aged 15-39 compared to children aged 0-14. Although shorter survival was observed in non-whites, an association between lower-SES neighborhood and shorter survival was significant only for non-Hispanic whites (NHWs) (p value for trend <0.05). Lack of insurance was significantly associated with shorter survival for all race/ethnicities examined except Asian/Pacific Islanders (p value < 0.05).


CONCLUSIONS
Lower survival in individuals diagnosed with leukemia was observed in adolescents and young adults compared to children and in non-whites compared to NHWs. Further, the independent effects on survival of both low SES and lack of insurance at diagnosis persisted after adjustment for demographic variables and varied across race/ethnicities.
Kent
Erin E
EE
Department of Epidemiology, University of California, Irvine, 224 Irvine Hall, Irvine, CA 92697-7555, USA. ebardin@uci.edu
Sender
Leonard S
LS
Largent
Joan A
JA
Anton-Culver
Hoda
H
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007938:Leukemia / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D016019:Survival Analysis; D055815:Young Adult