title: Nonbiological factors affecting survival in younger patients with acute myeloid leukemia.
abstract: BACKGROUND
  Progress has been made in determining the biological variants of acute myelogenous leukemia (AML) and their prognostic implications. However, to the authors' knowledge, little is known regarding the impact of nonbiological factors (NBFs) on the survival of patients with AML.
  
  
  METHODS
  The impact of NBFs (marital status, insurance status, county-level income, and education) on survival was assessed along with biological factors (disease subtype, sex, age, and race/ethnicity) using a cohort of patients aged 19 to 64 years who were diagnosed with AML between 2007 and 2011 and reported to the Surveillance, Epidemiology, and End Results program registry (SEER 18).
  
  
  RESULTS
  There were 5541 patients included. The median overall survival for the entire study population was 16 months. On multivariate analysis, an increased risk of death was independently linked to being a Medicaid beneficiary, uninsured, single, divorced, and residing in a county within the lower 3 quintiles of median household income. NBFs affected the risk of early (<2 months) and late mortality and their impact was confirmed among patients known to have received chemotherapy.
  
  
  CONCLUSIONS
  Insurance status, marital status, and county-level income were found to independently affect the survival of younger patients with AML and should be integrated into outcome comparisons. Interventions are needed to mitigate the impact of social factors on survival among patients with AML.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Uma Madhav
authors.initials: UM
authors.lastname: Borate
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Shin
authors.initials: S
authors.lastname: Mineishi
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Luciano Jose
authors.initials: LJ
authors.lastname: Costa
mesh_terms: D000328:Adult; D000367:Age Factors; D004522:Educational Status; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D015470:Leukemia, Myeloid, Acute / Q000401:mortality*; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015999:Multivariate Analysis; D044469:Racial Groups; D012189:Retrospective Studies; D018426:SEER Program; D012737:Sex Factors; D012923:Social Class; D015996:Survival Rate; D014481:United States
keywords: acute myelogenous leukemia; health care disparity; income; marital status; socioeconomic factors; survival