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Socioeconomic disparities and survival in paediatric AML

Presented by
Dr Lena Winestone, UCSF Benioff Children’s Hospital, USA
ASH 2019
Phase 3, AAML0531 and AAML1031
Children with acute myeloid leukaemia (AML) from low-income neighbourhoods enrolled in phase 3 clinical trials were 2.4 times more likely to die during treatment than children from middle- and high-income neighbourhoods [1].

Dr Lena E. Winestone (UCSF Benioff Children’s Hospital, USA) presented the first study to demonstrate that socioeconomic status, including income and educational status, is a key contributor to survival disparities in children with AML. Researchers concluded the origin of this disparity was not from chemotherapy, but that paediatric AML patients from low-income and low-education zip codes have lower 5-year overall survival compared with patients from middle-income and higher-educated zip codes.

Data for this evaluation was obtained from 1,467 children enrolled in the Children’s Oncology Group’s 2 recent phase 3 clinical trials AAML0531 and AAML1031. Patients were assessed by the income level of their postal code and by the average level of education for their area. Among the poverty, low income, and low education areas, a significantly higher proportion of children with AML enrolled in these trials were Black and Hispanic patients. Median annual household income was categorised using US Census data into 3 categories: poverty (less than $24,250; below the federal poverty line); low income ($24,250-56,516); middle/high income (greater than $56,516). Researchers also used US Census data to determine educational levels in a patient’s neighbourhood.

The median tumour burden at diagnosis was comparable between all groups. From middle/high-income areas, 68% of the children survived 5 years after diagnosis, compared with 61% surviving from low-income areas, and only 43% surviving from areas of poverty. Children from areas with a lower level of educational attainment were also shown to have lower rates of overall survival compared with those from areas with higher levels of educational attainment: 58% versus 70%, respectively. Patients from these low-income areas were determined to have a statistically significant higher risk of early death and treatment-related mortality on therapy, as well as more deaths due to toxicities from the chemotherapy treatment.

Taking other factors into account as potential confounders, such as insurance type or race, researchers found that these socioeconomic predictors of overall survival were still significant.

1. Winestone L, et al. Abstract 703, ASH 2019, 7-10 December, Orlando, USA.

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