title: How do differences in treatment impact racial and ethnic disparities in acute myeloid leukemia?
abstract: BACKGROUND
  We previously demonstrated disparate acute myelogenous leukemia (AML) survival for black and Hispanic patients; these differences persisted despite younger ages and higher prevalence of favorable cytogenetics in these groups. This study determined: (i) whether there are differences in treatment delivered to minorities, and (ii) how these differences affect outcomes in AML. We hypothesize that differences in treatment explain some proportion of survival disparities.
  
  
  METHODS
  We used California Cancer Registry data linked to hospital discharge abstracts for patients with AML (1998-2008). Logistic regression models estimated odds of treatment (chemotherapy and/or hematopoietic stem cell transplant) by race/ethnicity. Cox proportional hazard models estimated mortality by race after adjustment for treatment.
  
  
  RESULTS
  We analyzed 11,084 records. Black race was associated with lower odds of chemotherapy [OR, 0.74; 95% confidence interval (CI), 0.61-0.91]. Black and Hispanic patients had decreased odds of transplant [(OR, 0.64; 95% CI, 0.46-0.87); (OR, 0.74; 95% CI, 0.62-0.89), respectively]. Black patients had increased hazard of mortality (HR, 1.14; 95% CI, 1.04-1.25) compared with whites. Adjustment for receipt of any treatment resulted in decreased mortality (HR, 1.09; 95% CI, 1.00-1.20) for black patients.
  
  
  CONCLUSIONS
  AML treatment differences for black patients explain some proportion of the disparity. Future AML disparities studies should investigate socioeconomic and other characteristics.
  
  
  CONCLUSIONS
  Study findings may better elucidate drivers of disparities in AML.
authors: Division Hematology and Oncology, Stanford University, Stanford, California. manalip@stanford.edu.
authors: Manali I
authors: MI
authors: Patel
authors: Department of Surgery, Stanford University, Stanford, California. Stanford Cancer Institute, Stanford, California.
authors: Yifei
authors: Y
authors: Ma
authors: Division Hematology and Oncology, Stanford University, Stanford, California. Stanford Cancer Institute, Stanford, California.
authors: Beverly
authors: B
authors: Mitchell
authors: Department of Surgery, Stanford University, Stanford, California. Stanford Cancer Institute, Stanford, California.
authors: Kim F
authors: KF
authors: Rhoads
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002140:California; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000208:ethnology* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents