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328045
Survival Disparities in Pediatric Acute Lymphocytic Leukemia and Acute Myeloid Leukemia: An Analysis of Population-Based Florida Cancer Registry (1981-2009)


Tuesday, November 3, 2015

Erin Dunn, BA, MD/MPH Candidate, Medical Education and Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
Kevin J. Moore, BA, MD/MPH (c), Medical Education and Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
Feng Miao, MSc, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
Tulay Koru-Sengul, MHS, PhD, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
Background: Leukemia is the most common childhood and teenage cancer, with Acute Lymphocytic Leukemia(ALL) more common than Acute Myeloid Leukemia(AML) and Chronic Myeloid Leukemia(CML). We elucidated ALL and AML survival disparities in Floridian pediatric population(ages0-19) across race/ethnicity, neighborhood poverty status(NPS), and gender.

Methods: Florida Cancer Data System(1981-2009) was linked with US census to explore median survival and 1-, 3-, 5-year survival rates by demographics. Survival was compared by gender, race/ethnicity, NPS and modeled with multivariate Cox regression to calculate hazard ratio(HR) and 95% confidence interval(95%CI).

Results: Of the 3,679 pediatric leukemia cases, 79.2% were ALL, 17.4%AML, 3.4%CML.

Overall ALL median survival was 3.4yrs(95%CI:3.1-3.8) where Whites(3.8;3.4-4.2) had longer survival than Blacks(2.2;1.8-2.5) and Other races(3.0). Hispanics(4.6;3.4-6.0) had longer survival than non-Hispanics(3.2). Middle-high NPS(3.9;3.2-5.4) had longest median survival; lowest NPS had shortest(2.8). Males(3.4) and females(3.5) had similar survival.

AML median survival was 1.2 yrs(1.0-1.3) with Whites(1.2;1.1-1.4) having longer survival than Blacks(1.0;0.8-1.7) and Other race(1.1). Hispanics(1.3;1.1-1.8) had similar survival to non-Hispanics(1.1). For pediatric AML, median survival was similar for all NPS and between males(1.2) and females(1.1).

Blacks had worse ALL survival compared to Whites(HR=[1.7];95%CI:1.4-2.1), and Hispanics had better survival than non-Hispanics([0.7];0.6-0.8). Middle-high NPS had better survival than lowest NPS([0.8];0.6-1.0). Similar significant survival disparities were not found for AML.

Conclusions: Elucidating ALL and AML survival showed race/ethnicity, NPS, and gender differences within and between the most common pediatric leukemias. Survival disparities were seen in ALL but not AML. Understanding ALL and AML survival differences may provide a base for culturally competent pediatric cancer prevention programs.

Learning Areas:

Epidemiology
Public health or related research

Learning Objectives:
Describe ALL and AML survival differences between race/ethnicity, SES, and gender within and between the most common pediatric leukemia types.

Keyword(s): Cancer, Children and Adolescents

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a second-year medical student who researches cancer epidemiology and disparities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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