Yimei Li1,2, Joanna G Newton3, Kelly D Getz2, Yuan-Shung Huang4, Alix E Seif1, Brian T Fisher1,2, Richard Aplenc1,2, Lena E Winestone1,5. 1. Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. 2. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, Georgia. 4. Healthcare Analytics Unit, Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 5. Division of Allergy, Immunology & BMT, Department of Pediatrics, University of California - San Francisco, San Francisco, California.
Abstract
BACKGROUND: Black patients with acute myeloid leukemia (AML) are more likely to present with high acuity and consequently experience higher rates of induction mortality than white patients. Given the consistently identified racial disparities in overall survival (OS) among patients with AML, we aimed to evaluate whether there were sustained on-therapy racial differences in inpatient mortality, intensive care unit (ICU) requirements, or supportive care beyond initial induction. PROCEDURE: Within a retrospective cohort of 1239 children diagnosed with AML between 2004 and 2014 in the Pediatric Health Information System (PHIS) database who survived their initial course of induction chemotherapy, we compared on-therapy inpatient mortality, ICU-level care requirements, treatment course duration, cumulative length of hospital stay (LOS), and resource utilization after induction I by race. RESULTS: Over the period from the start of induction II through completion of frontline chemotherapy, there were no significant differences in mortality (adjusted odds ratios [OR], 1.01; 95% confidence intervals [CI], 0.41-2.48), ICU-level care requirements (adjusted OR, 0.93; 95% CI, 0.69-1.26), LOS (adjusted mean difference, 3.2 days; 95% CI, -2.3-9.6), or supportive care resource utilization for black patients relative to white patients. Course-specific analyses also demonstrated no differences by race. CONCLUSION: Although black patients have higher acuity at presentation and higher induction mortality, such disparities do not persist over subsequent frontline chemotherapy treatment. This finding allows interventions aimed at reducing disparities to be directed at presentation and induction.
BACKGROUND: Black patients with acute myeloid leukemia (AML) are more likely to present with high acuity and consequently experience higher rates of induction mortality than white patients. Given the consistently identified racial disparities in overall survival (OS) among patients with AML, we aimed to evaluate whether there were sustained on-therapy racial differences in inpatient mortality, intensive care unit (ICU) requirements, or supportive care beyond initial induction. PROCEDURE: Within a retrospective cohort of 1239 children diagnosed with AML between 2004 and 2014 in the Pediatric Health Information System (PHIS) database who survived their initial course of induction chemotherapy, we compared on-therapy inpatient mortality, ICU-level care requirements, treatment course duration, cumulative length of hospital stay (LOS), and resource utilization after induction I by race. RESULTS: Over the period from the start of induction II through completion of frontline chemotherapy, there were no significant differences in mortality (adjusted odds ratios [OR], 1.01; 95% confidence intervals [CI], 0.41-2.48), ICU-level care requirements (adjusted OR, 0.93; 95% CI, 0.69-1.26), LOS (adjusted mean difference, 3.2 days; 95% CI, -2.3-9.6), or supportive care resource utilization for black patients relative to white patients. Course-specific analyses also demonstrated no differences by race. CONCLUSION: Although black patients have higher acuity at presentation and higher induction mortality, such disparities do not persist over subsequent frontline chemotherapy treatment. This finding allows interventions aimed at reducing disparities to be directed at presentation and induction.
Authors: Marko Kavcic; Brian T Fisher; Yimei Li; Alix E Seif; Kari Torp; Dana M Walker; Yuan-Shung Huang; Grace E Lee; Sarah K Tasian; Marijana Vujkovic; Rochelle Bagatell; Richard Aplenc Journal: Cancer Date: 2013-02-21 Impact factor: 6.860
Authors: Lena E Winestone; Kelly D Getz; Tamara P Miller; Jennifer J Wilkes; Leah Sack; Yimei Li; Yuan-Shung Huang; Alix E Seif; Rochelle Bagatell; Brian T Fisher; Andrew J Epstein; Richard Aplenc Journal: Am J Hematol Date: 2016-12-07 Impact factor: 10.047
Authors: Alan S Gamis; Todd A Alonzo; Soheil Meshinchi; Lillian Sung; Robert B Gerbing; Susana C Raimondi; Betsy A Hirsch; Samir B Kahwash; Amy Heerema-McKenney; Laura Winter; Kathleen Glick; Stella M Davies; Patti Byron; Franklin O Smith; Richard Aplenc Journal: J Clin Oncol Date: 2014-09-20 Impact factor: 44.544
Authors: Geoffrey C Buckle; Jennifer Pfau Collins; Peter Odada Sumba; Beccy Nakalema; Dorine Omenah; Kristine Stiffler; Corey Casper; Juliana A Otieno; Jackson Orem; Ann M Moormann Journal: Infect Agent Cancer Date: 2013-09-30 Impact factor: 2.965