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Statewide geographic variation in outcomes for adults with acute myeloid leukemia in North Carolina
Author(s) -
Freeman Ashley T.,
Meyer AnneMarie,
Smitherman Andrew B.,
Zhou Lei,
Basch Ethan M.,
Shea Thomas C.,
Wood William A.
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30139
Subject(s) - medicine , hazard ratio , cancer registry , confidence interval , population , cancer , proportional hazards model , referral , environmental health , family medicine
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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 .