title: Predictors of early death and survival among children, adolescents and young adults with acute myeloid leukaemia in California, 1988-2011: a population-based study.
abstract: A better understanding of factors associated with early death and survival among children, adolescents and young adults with acute myeloid leukaemia (AML) may guide health policy aimed at improving outcomes in these patients. We examined trends in early death and survival among 3935 patients aged 0-39 years with de novo AML in California during 1988-2011 and investigated the associations between sociodemographic and selected clinical factors and outcomes. Early death declined from 9·7% in 1988-1995 to 7·1% in 2004-2011 (P = 0·062), and survival improved substantially over time. However, 5-year survival was still only 50% (95% confidence interval 47-53%) even in the most recent treatment period (2004-2011). Overall, the main factors associated with poor outcomes were older age at diagnosis, treatment at hospitals not affiliated with National Cancer Institute-designated cancer centres, and black race/ethnicity. For patients diagnosed during 1996-2011, survival was lower among those who lacked health insurance compared to those with public or private insurance. We conclude that mortality after AML remained strikingly high in California and increased with age. Possible strategies to improve outcomes include wider insurance coverage and treatment at specialized cancer centres.
authors: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.|Cancer Prevention Institute of California, Fremont, CA, USA.
authors: Renata
authors: http://orcid.org/0000-0001-7707-9974
authors: R
authors: Abrahão
authors: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors: Ruth H
authors: RH
authors: Keogh
authors: Cancer Prevention Institute of California, Fremont, CA, USA.
authors: Daphne Y
authors: DY
authors: Lichtensztajn
authors: Epidemiology Unity and Cancer Registry of Girona, Girona Biomedical Research Institute, Girona, Spain.
authors: Rafael
authors: R
authors: Marcos-Gragera
authors: Division of Hematology, Stanford University School of Medicine, Stanford, CA, USA.
authors: Bruno C
authors: BC
authors: Medeiros
authors: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors: Michel P
authors: MP
authors: Coleman
authors: Leukemia and Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: Raul C
authors: RC
authors: Ribeiro
authors: Cancer Prevention Institute of California, Fremont, CA, USA.|Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
authors: Theresa H M
authors: TH
authors: Keegan
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000401:mortality*; D008297:Male; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: acute myeloid leukaemia; early death; population-based; survival