title: Statewide geographic variation in outcomes for adults with acute myeloid leukemia in North Carolina.
abstract: Population-based studies have demonstrated survival disparities related to socioeconomic factors for patients with acute myeloid leukemia (AML). The objective of the current study was to determine whether the local health care infrastructure, represented by Area Health Education Centers (AHEC) region, or treating center experience, represented by National Cancer Institute Comprehensive Cancer Center (NCICCC) designation, were associated with outcomes among patients with AML in North Carolina.
  
  
  
  Patients who were diagnosed with AML from 2003 to 2009 were identified using the University of North Carolina Lineberger Integrated Cancer Information and Surveillance System, a database linking insurance claims to the North Carolina Cancer Registry. A Cox proportional-hazards model was used to explore survival based on AHEC region. A subset of patients who received inpatient chemotherapy was examined to evaluate the impact of treatment at an NCICCC.
  
  
  
  Nine hundred patients were identified in the study period, 553 of whom received inpatient chemotherapy therapy within 30 days of diagnosis. Almost one-half of these patients (n = 294) received chemotherapy at a non-NCICCC. Among the patients who received intensive inpatient therapy, residence in 3 of 9 AHEC regions was associated with a higher risk of mortality (hazard ratio: range, 1.97-4.03; P < .01) at 1 year in multivariate analysis. Treatment at a non-NCICCC was not associated with an increased risk of mortality at 1 year (hazard ratio, 1.25; 95% confidence interval, 0.95-1.65).
  
  
  
  Survival among patients with AML in North Carolina varies according to geographic region. Further examination of local practice and referral patterns may inform strategies to improve AML outcomes across the state. Cancer 2016;122:3041-3050. © 2016 American Cancer Society.
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina. ashley.freeman@unchealth.unc.edu.
authors.forename: Ashley T
authors.initials: AT
authors.lastname: Freeman
authors.affiliation: Integrated Cancer Information and Surveillance System, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Meyer
authors.affiliation: Division of Pediatric Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Smitherman
authors.affiliation: Integrated Cancer Information and Surveillance System, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Basch
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Shea
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000592:standards*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D054547:National Cancer Institute (U.S.); D009367:Neoplasm Staging; D009657:North Carolina; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D055815:Young Adult
keywords: Area Health Education Centers; North Carolina; acute myeloid leukemia; disparities; survival