Open AccessQuest for Universal Health Coverage for Pediatric Acute Lymphoblastic Leukemia in Mexico
Author(s) -
Paloma Muñoz-Aguirre,
R. Huerta,
Martín Lajous
Publication year - 2020
Publication title -
jco global oncology
Language(s) - English
Resource type - Journals
ISSN - 2687-8941
DOI - 10.1200/go.20.12000
Subject(s) - medicine , hematologist , proportional hazards model , hazard ratio , lymphoblastic leukemia , survival analysis , confidence interval , pediatrics , residence , leukemia , demography , disease , sociology
PURPOSE Until 2005, most Mexican children did not have coverage for cancer treatment. In that year, Seguro Popular began funding the treatment of children with acute lymphoblastic leukemia (ALL). We aimed to estimate 5-year survival in children with ALL. We also sought to evaluate the relationship of hospital volume, out-of-state treatment, and treatment administered by an adult hematologist to 5-year survival.METHODS We categorized patients according to risk (National Cancer Institute age criteria), hospital volume, out-of-state treatment, and treatment administered by an adult hematologist. We obtained overall 5-year survival using the Kaplan-Meier method and compared survival among groups. We used Cox proportional hazards regression analysis to conduct multivariable analysis and obtained hazard ratios (HRs) and 95% CI.RESULTS Between 2005 and 2015, 9,555 children were treated for ALL under Seguro Popular. Mean age (± standard deviation) was 7.4 (4.7) years. Five-year overall survival was 61% (95% CI, 60% to 62%); survival for high-risk patients was 51% (95% CI, 49% to 52%) and 66% (95% CI, 65% to 67%) for those with standard risk. We observed state heterogeneity (Sinaloa: 75% [95% CI, 69% to 80%] v Campeche: 45% [95% CI, 54% to 62%]). Patients who were treated in low-volume hospitals had lower survival rates compared with those treated in medium- and high-volume hospitals (HR v low, 1.17 [95% CI, 1.08 to 1.26]). Patients treated outside of their residence state had 10% lower mortality compared with those treated in their home state (HR, 0.89 [95% CI, 0.82 to 0.99]). The hazard of death among children who were treated by an adult hematologist was 1.93 times (95% CI, 1.44 times to 2.57 times) higher than the hazard of death among those treated by a pediatric oncologist/hematologist (26% [95% CI, 16% to 37%] v 61% [95% CI, 60% to 62%]).CONCLUSION Our results highlight the disparities in survival for ALL in Mexico. Health reform must consider increasing the patient volume required for hospital accreditation and mandating treatment by pediatric oncologists/hematologists.