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Area deprivation is associated with poorer overall survival in children with acute lymphoblastic leukemia
Author(s) -
Schraw Jeremy M.,
PeckhamGregory Erin C.,
Rabin Karen R.,
Scheurer Michael E.,
Lupo Philip J.,
Oluyomi Abiodun
Publication year - 2020
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28525
Subject(s) - medicine , hazard ratio , demography , disadvantaged , quartile , socioeconomic status , confidence interval , residence , proportional hazards model , ethnic group , pediatrics , gerontology , population , environmental health , sociology , political science , anthropology , law
Background Few studies have evaluated social determinants of outcomes disparities for children with acute lymphoblastic leukemia (ALL). We investigated the association of area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, with overall survival (OS) among children and adolescents with ALL. Procedure We obtained demographic and clinical data, geocoded addresses at diagnosis, and vital status on all Texas children diagnosed with ALL from 1995 to 2011 (N = 4104). Using the US Census Bureau 2010 geography, we computed ADI scores for all census tracts in Texas and grouped the tracts into quartiles: least, third‐most, second‐most, and most disadvantaged. We mapped children to ADI quartiles based on residence at diagnosis, and estimated OS using Cox regression adjusting for sex, race/ethnicity, age, and metropolitan/nonmetropolitan residence. Results Five‐year OS ranged from 89% (95% confidence interval [CI] 87‐91%) for children in the least disadvantaged tracts to 79% (95% CI 76‐81%) for children in the most disadvantaged tracts ( P = 4E‐7). An elevated hazard ratio (HR) for death was observed for children in the most disadvantaged tracts (HR 1.57, 95% CI 1.23‐2.00), and trends toward increased mortality were observed in the third‐most and second‐most disadvantaged tracts (HR 1.23, 95% CI 0.97‐1.57 and HR 1.27, 95% CI 0.99‐1.62, respectively). In stratified analyses, area disadvantage was more strongly associated with OS in males than females. Conclusions Neighborhood socioeconomic disadvantage is associated with inferior OS in this analysis of over 4100 children with ALL, highlighting the substantial contributions of social‐environmental factors to childhood cancer survival. This association was stronger in males than females.