Dataset Information

Are social inequalities in acute myeloid leukemia survival explained by differences in treatment utilization? Results from a French longitudinal observational study among older patients.

ABSTRACT:

Background

Evidences support social inequalities in cancer survival. Studies on hematological malignancies, and more specifically Acute Myeloid Leukemia (AML), are sparser. Our study assessed: 1/ the influence of patients' socioeconomic position on survival, 2/ the role of treatment in this relationship, and 3/ the influence of patients' socioeconomic position on treatment utilization.

Methods

This prospective multicenter study includes all patients aged 60 and older, newly diagnosed with AML, excluding promyelocytic subtypes, between 1st January 2009 to 31st December 2014 in the South-West of France. Data came from medical files. Patients' socioeconomic position was measured by an ecological deprivation index, the European Deprivation Index. We studied first, patients' socioeconomic position influence on overall survival (n?=?592), second, on the use of intensive chemotherapy (n?=?592), and third, on the use of low intensive treatment versus best supportive care among patients judged unfit for intensive chemotherapy (n?=?405).

Results

We found an influence of patients' socioeconomic position on survival (highest versus lowest position HR_Q5: 1.39 [1.05;1.87] that was downsized to become no more significant after adjustment for AML ontogeny (HR_Q5: 1.31[0.97;1.76] and cytogenetic prognosis HR_Q5: 1.30[0.97;1.75]). The treatment was strongly associated with survival. A lower proportion of intensive chemotherapy was observed among patients with lowest socioeconomic position (OR_Q5: 0.41[0.19;0.90]) which did not persist after adjustment for AML ontogeny (OR_Q5: 0.59[0.25;1.40]). No such influence of patients' socioeconomic position was found on the treatment allocation among patients judged unfit for intensive chemotherapy.

Conclusions

Finally, these results suggest an indirect influence of patients' socioeconomic position on survival through AML initial presentation.

SUBMITTER: Berger E

PROVIDER: S-EPMC6729078 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Publications

Are social inequalities in acute myeloid leukemia survival explained by differences in treatment utilization? Results from a French longitudinal observational study among older patients.

Berger Eloïse E Delpierre Cyrille C Despas Fabien F Bertoli Sarah S Bérard Emilie E Bombarde Oriane O Bories Pierre P Sarry Audrey A Laurent Guy G Récher Christian C Lamy Sébastien S

BMC cancer 20190905 1

<h4>Background</h4>Evidences support social inequalities in cancer survival. Studies on hematological malignancies, and more specifically Acute Myeloid Leukemia (AML), are sparser. Our study assessed: 1/ the influence of patients' socioeconomic position on survival, 2/ the role of treatment in this relationship, and 3/ the influence of patients' socioeconomic position on treatment utilization.<h4>Methods</h4>This prospective multicenter study includes all patients aged 60 and older, newly diagno ...[more]

PMID: 31488077

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Project description:BackgroundSubstantial increases in height have occurred concurrently with economic development in most populations during the last century. In high-income countries, environmental exposures that can limit genetic growth potential appear to have lessened, and variation in height by socioeconomic position may have diminished. The objective of this study is to investigate inequalities in height in a cohort of children born in the early 1990s in England, and to evaluate which factors might explain any identified inequalities.Methods and findings12,830 children from The Avon Longitudinal Study of Parents and Children (ALSPAC), a population based cohort from birth to about 11.5 years of age, were used in this analysis. Gender- and age-specific z-scores of height at different ages were used as outcome variables. Multilevel models were used to take into account the repeated measures of height and to analyze gender- and age-specific relative changes in height from birth to 11.5 years. Maternal education was the main exposure variable used to examine socioeconomic inequalities. The roles of parental and family characteristics in explaining any observed differences between maternal education and child height were investigated. Children whose mothers had the highest education compared to those with none or a basic level of education, were 0.39 cm longer at birth (95% CI: 0.30 to 0.48). These differences persisted and at 11.5 years the height difference was 1.4 cm (95% CI: 1.07 to 1.74). Several other factors were related to offspring height, but few changed the relationship with maternal education. The one exception was mid-parental height, which fully accounted for the maternal educational differences in offspring height.ConclusionsIn a cohort of children born in the 1990s, mothers with higher education gave birth to taller boys and girls. Although height differences were small they persisted throughout childhood. Maternal and paternal height fully explained these differences.

Dataset Information

Are social inequalities in acute myeloid leukemia survival explained by differences in treatment utilization? Results from a French longitudinal observational study among older patients.

Background

Methods

Results

Conclusions

Publications

Are social inequalities in acute myeloid leukemia survival explained by differences in treatment utilization? Results from a French longitudinal observational study among older patients.

Similar Datasets

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