Sociodemographic disparities in chemotherapy and hematopoietic cell transplantation utilization among adult acute lymphoblastic and acute myeloid leukemia patients

• Published in: PloS one Vol. 12; no. 4; p. e0174760
• Main Authors: Jabo, Brice, Morgan, John W, Martinez, Maria Elena, Ghamsary, Mark, Wieduwilt, Matthew J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.04.2017; Public Library of Science (PLoS)
• Subjects: Acute lymphoblastic leukemia; Acute myelocytic leukemia; Acute myeloid leukemia; Acute promyeloid leukemia; Adolescent; Adult; Age; Aged; Analysis; Antineoplastic Agents - therapeutic use; Arches; Autografts; Availability; Binary data; Blood; Breast cancer; Cadmium; Cancer; Cancer therapies; Care and treatment; Census; Census of Population; Cervical cancer; Cervix; Chemotherapy; Classification; Clinical trials; Colon; Colorectal carcinoma; Combined Modality Therapy; Complications; Computation; Computer programs; Conditioning; Constrictions; Control; Demography; Diagnosis; Diseases; Donors; Epidemiology; Estimates; Ethnic factors; Ethnicity; Female; Females; Government programs; Health care; Health care disparities; Health risk assessment; Health surveillance; Hematology; Hematopoietic Stem Cell Transplantation; Hispanic people; Historical account; Humans; Incidence; Income; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - therapy; Lymphatic leukemia; Male; Males; Marital status; Medicaid; Medical research; Medicine and Health Sciences; Middle Aged; Minority & ethnic groups; Myeloid leukemia; Older people; Oncology; People and Places; Population studies; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Promyeloid leukemia; Public health; Radiation; Radiation therapy; Receiving; Rectum; Regression analysis; Risk; Social Class; Social Sciences; Sociodemographics; Socioeconomic factors; Socioeconomics; Statistics; Stem cell transplantation; Stem cells; Studies; Transplantation; Transplants & implants; Utilization; Young Adult; California; La Jolla California; United States > US; Loma Linda California
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0174760

Identifying sociodemographic disparities in chemotherapy and hematopoietic cell transplantation (HCT) utilization for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) may improve survival for underserved populations. In this study, we incorporate neighborhood socioeconomic status (nSES), marital status, and distance from transplant center with previously studied factors to provide a comprehensive analysis of sociodemographic factors influencing treatments for ALL and AML. Using the California Cancer Registry, we performed a retrospective, population-based study of patients ≥15 years old with ALL (n = 3,221) or AML (n = 10,029) from 2003 through 2012. The effect of age, sex, race/ethnicity, marital status, nSES, and distance from nearest transplant center on receiving no treatment, chemotherapy alone, or chemotherapy then HCT was analyzed. No treatment, chemotherapy alone, or chemotherapy then HCT were received by 11%, 75%, and 14% of ALL patients and 36%, 53%, and 11% of AML patients, respectively. For ALL patients ≥60 years old, HCT utilization increased from 5% in 2005 to 9% in 2012 (p = 0.03). For AML patients ≥60 years old, chemotherapy utilization increased from 39% to 58% (p<0.001) and HCT utilization from 5% to 9% from 2005 to 2012 (p<0.001). Covariate-adjusted analysis revealed decreasing relative risk (RR) of chemotherapy with increasing age for both ALL and AML (trend p <0.001). Relative to non-Hispanic whites, lower HCT utilization occurred in Hispanic [ALL, RR = 0.80 (95% CI = 0.65-0.98); AML, RR = 0.86 (95% CI = 0.75-0.99)] and non-Hispanic black patients [ALL, RR = 0.40 (95% CI = 0.18-0.89); AML, RR = 0.60 (95% CI = 0.44-0.83)]. Compared to married patients, never married patients had a lower RR of receiving chemotherapy [ALL, RR = 0.96 (95% CI = 0.92-0.99); AML, RR = 0.94 (95% CI = 0.90-0.98)] or HCT [ALL, RR = 0.58 (95% CI = 0.47-0.71); AML, RR = 0.80 (95% CI = 0.70-0.90)]. Lower nSES quintiles predicted lower chemotherapy and HCT utilization for both ALL and AML (trend p <0.001). Older age, lower nSES, and being unmarried predicted lower utilization of chemotherapy and HCT among ALL and AML patients whereas having Hispanic or black race/ethnicity predicted lower rates of HCT. Addressing these disparities may increase utilization of curative therapies in underserved acute leukemia populations.