title: Understanding disparities in leukemia: a national study.
abstract: OBJECTIVE
  Disparities in solid tumors have been well studied. However, disparities in hematologic malignancies have been relatively unexplored on population-based levels. The purpose of this study is to examine the relationship between race/ethnicity and acute leukemia mortality.
  
  
  METHODS
  All patients with acute leukemia [acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML)] were identified in the Surveillance Epidemiology and End Results database, 1999-2008. Kaplan-Meier curves were generated to reflect survival probabilities by race/ethnicity. Multivariable Cox proportional hazard models estimated hazard of mortality by race with adjustment for individual (age, gender, year of diagnosis) and select genetic factors.
  
  
  RESULTS
  A total of 39,002 patients with acute leukemia were included in the study. Overall, there was a mortality disparity in acute leukemia for blacks (HR 1.17, p < 0.0001) and Hispanics (HR 1.13, p < 0.0001) compared with non-Hispanic whites. In stratified analysis, disparities in ALL were greater than AML; blacks (HR[ALL]1.45, p < 0.0001; HR[AML]1.12, p < 0.0011); Hispanics (HR[ALL]1.46, p < 0.0001; HR[AML]1.06, p < 0.0001). Adjustment for individual patient and select genetic factors did not explain disparities.
  
  
  CONCLUSIONS
  Blacks and Hispanics suffer decreased survival in acute leukemia as compared to others. Further investigation is needed to understand the drivers of poor cancer outcomes in these populations.
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA. tarheelmanali@gmail.com
authors.forename: M I
authors.initials: MI
authors.lastname: Patel
authors.forename: Y
authors.initials: Y
authors.lastname: Ma
authors.forename: B S
authors.initials: BS
authors.lastname: Mitchell
authors.forename: K F
authors.initials: KF
authors.lastname: Rhoads
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D055815:Young Adult