title: Effects of Race/Ethnicity and Socioeconomic Status on Outcome in Childhood Acute Lymphoblastic Leukemia.
abstract: With modern therapy, overall survival (OS) for children with acute lymphoblastic leukemia approaches 90%. However, inferior outcomes for minority children have been reported. Data on the effects of ethnicity/race as it relates to socioeconomic status are limited. Using state cancer registry data from Texas and Florida, we evaluated the impact of neighborhood-level poverty rate and race/ethnicity on OS for 4719 children with acute lymphoblastic leukemia. On multivariable analysis, patients residing in neighborhoods with the highest poverty rate had a 1.8-fold increase in mortality compared with patients residing in neighborhoods with the lowest poverty rate (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.41-2.30). Hispanic and non-Hispanic black patients also had increased risk of mortality compared with non-Hispanic white patients (Hispanic: HR, 1.18; 95% CI, 1.01-1.39; non-Hispanic black: HR, 1.31; 95% CI, 1.03-1.66). On subgroup analysis, there was a 21.7% difference in 5-year OS when comparing non-Hispanic white children living in the lowest poverty neighborhoods (5-year OS, 91.2%; 95% CI, 88.6-93.2) to non-Hispanic black children living in the highest poverty neighborhoods (5-year OS, 69.5%; 95% CI, 61.5-76.1). To address such disparities in survival, further work is needed to identify barriers to cancer care in this pediatric population.
authors.affiliation: *Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO †Department of Radiation Oncology, Vanderbilt University School of Medicine ‡The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN.
authors.forename: Sahaja
authors.initials: S
authors.lastname: Acharya
authors.forename: Samantha
authors.initials: S
authors.lastname: Hsieh
authors.forename: Eric T
authors.initials: ET
authors.lastname: Shinohara
authors.forename: Todd
authors.initials: T
authors.lastname: DeWees
authors.forename: Haydar
authors.initials: H
authors.lastname: Frangoul
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Perkins
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D005431:Florida; D006801:Humans; D007223:Infant; D008297:Male; D008913:Minority Groups; D011203:Poverty; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000191:economics / Q000208:ethnology / Q000401:mortality*; D044469:Racial Groups; D012042:Registries; D012923:Social Class; D015996:Survival Rate; D013781:Texas; D016896:Treatment Outcome