Format

Send to

Choose Destination
See comment in PubMed Commons below
Am J Hematol. 2017 Feb;92(2):141-148. doi: 10.1002/ajh.24605. Epub 2016 Dec 7.

The role of acuity of illness at presentation in early mortality in black children with acute myeloid leukemia.

Winestone LE1,2,3, Getz KD1,2, Miller TP1,2, Wilkes JJ1,2,3, Sack L1, Li Y4, Huang YS5, Seif AE1,6, Bagatell R1,6, Fisher BT2,7,8, Epstein AJ3,9,10, Aplenc R1,2,6,8.

Author information

1
Division of Oncology, The Children's Hospital of Philadelphia, Pennsylvania.
2
Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania.
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Pennsylvania.
4
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania.
5
Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Pennsylvania.
6
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania.
7
Division of Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania.
8
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania.
9
Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Pennsylvania.
10
Department of Veterans Affairs' Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Pennsylvania.

Abstract

Black patients with acute myeloid leukemia (AML) experience higher mortality than White patients. We compared induction mortality, acuity of illness prior to chemotherapy, and insurance type between Black and White patients to assess whether acuity of presentation mediates the disparity. Within a retrospective cohort of 1,122 children with AML treated with two courses of standard induction chemotherapy between 2004 and 2014 in the Pediatric Health Information System (PHIS) database, the association between race (Black versus White) and inpatient mortality during induction was examined. Intensive Care Unit (ICU)-level resource utilization during the first 72 hours following admission for initial AML chemotherapy was evaluated as a potential mediator. The total effect of race on mortality during Induction I revealed a strong association (unadjusted HR 2.75, CI: 1.18, 6.41). Black patients had a significantly higher unadjusted risk of requiring ICU-level resources within the first 72 hours after initial presentation (17% versus 11%; RR 1.52, CI: 1.04, 2.24). Mediation analyses revealed the indirect effect of race through acuity accounted for 61% of the relative excess mortality during Induction I. Publicly insured patients experienced greater induction mortality than privately insured patients regardless of race. Black patients with AML have significantly greater risk of induction mortality and are at increased risk for requiring ICU-level resources soon after presentation. Higher acuity amongst Black patients accounts for a substantial portion of the relative excess mortality during Induction I. Targeting factors affecting acuity of illness at presentation may lessen racial disparities in AML induction mortality.

PMID:
27862214
DOI:
10.1002/ajh.24605
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Wiley
    Loading ...
    Support Center