title: Racial Differences in the Overall Survival of Hairy Cell Leukemia in the United States: A Population-Based Analysis of the Surveillance, Epidemiology, and End Results Database.
abstract: BACKGROUND
  Several studies have reported excellent long-term overall survival (OS) of patients with hairy cell leukemia (HCL) without racial disparity. Studies in other cancers have demonstrated worse mortality among African American (AA) individuals.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results 18 database to identify HCL patients diagnosed between 1978 and 2011. Kaplan-Meier curves were plotted to estimate OS. Univariate analysis using the life table method and multivariate Cox regression model were used to determine the independent effect of race on OS.
  
  
  RESULTS
  The study population included 78% men and had a median age of 56 years. Race included 93% white, 3.5% Asian/Pacific Islander, and 3.5% AA. The 10-year OS was significantly less for AA as compared with white and Asian/Pacific Islander individuals (54% vs. 72% vs. 75%; P < .001). A Kaplan-Meier survival curve showed a significantly worse OS for AA versus other races (P < .001). In a multivariate analysis, AA race remained an independent predictor for a worse OS (hazard ratio 1.77; 95% confidence interval, 1.30-2.40; P < .001) after adjusting for age, sex, year of diagnosis, and marital status.
  
  
  CONCLUSIONS
  In this population-based study, only half of AA patients but more than two-thirds of HCL patients from other racial groups were alive at 10 years. Such drastic racial differences in OS of HCL patients at the population level mandates further evaluation of the contributory biological, socioeconomic, health system, and other factors. Understanding and overcoming such racial disparities might close the racial differences in OS of this potentially curable disease.
authors.affiliation: Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Smith
authors.initials: S
authors.lastname: Giri
authors.affiliation: Department of Medicine, Memorial Hospital of Rhode Island, Brown University, Providence, RI.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Shrestha
authors.affiliation: Department of Medicine, Reading Health System, Reading, PA.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Pathak
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: vijaya.bhatt@unmc.edu.
authors.forename: Vijaya Raj
authors.initials: VR
authors.lastname: Bhatt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007943:Leukemia, Hairy Cell / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States; D055815:Young Adult
keywords: African American; Caucasian; Indolent B-cell lymphoproliferative disorder; Marital status; Racial disparity