ALBERT

Description: Purpose In our previous work using the Surveillance Epidemiology and End Results (SEER) database, we demonstrated that despite younger age at presentation and a higher prevalence of favorable cytogenetic factors, black and Hispanic patients have increased mortality from Acute Myeloid Leukemia (AML) compared with non-Hispanic whites (NHW). The role of treatment has not been studied on a population level due to the limitations of SEER data with respect to treatment variables. The purpose of this study is to explore explanations for disparities in AML using a novel database containing both demographic and clinical variables. We will evaluate the relationship between the quality of AML care and outcomes. The hypothesis is that outcome disparities from AML may be explained by differences in receipt of treatment by race/ethnicity. Methods All patients with AML were identified in the California Cancer Registry (CCR) database linked to the hospital discharge abstracts from the Office of Statewide Health Planning and Development (OSHPD) during the years 1998-2008. Kaplan Meier (KM) survival curves were generated to predict survival probabilities by race/ethnicity. These were stratified by age based on our prior findings. Logistic regression models estimated the odds of treatment defined as chemotherapy and/or hematopoietic stem cell transplant by race/ethnicity. Cox proportional hazard models estimated the hazard of mortality by race with adjustment for age, gender, year of diagnosis, co-morbidities, and presence of the t(8;21), APL, and 11q23 subtypes. Models were further adjusted for receipt of treatment. Results A total of 11,084 patients were included in the study. Black and Hispanic patients were diagnosed at younger ages (

Description: Background: Previously, we demonstrated mortality disparities for minorities with Acute Leukemia (AL) despite favorable demographic and genetic prognostic factors. We also showed that differences in treatment by race/ethnicity explained a large component of this disparity. However, due to the limitations of the Surveillance Epidemiology and End Results (SEER) stand-alone database, we could not explore the association between AL mortality and socioeconomic status (SES) factors. The purpose of the current study is to determine how SES impacts racial/ethnic differences in AL mortality using an expanded SEER-SES linked dataset. Because SES may influence the receipt of high quality care, we hypothesize that SES factors will explain some proportion of AL mortality disparities. Methods: Patients with acute lymphocytic (ALL) and acute myeloid (AML) leukemia were identified in SEER and linked to the National Longitudinal Mortality Study (NLMS). The NLMS contains patient-level SES factors collected by in-person and telephone interview surveys for a random sample in the United States Census Bureau Current Population Surveys (CPS) from the years 1979 to 2011. The SEER-NLMS linkage includes detailed cancer information (date of diagnosis, type of cancer, cause of death) and detailed SES factors (marital status, education, income, home ownership, occupation, insurance status) as well as individual demographic factors (age, gender, race/ethnicity). Cox proportional hazard models were built to estimate the hazard of mortality by race/ethnicity after consideration of individual, clinical, and SES factors. Results: A total of 621 patients were diagnosed with ALL and AML during the study period. Thirty-six records were excluded due to missing data leaving 124 (21%) patients with ALL and 461 (79%) with AML in the analysis. ALL: The majority of patients were non-Hispanic white (NHW) (n=73; 59%), followed by Hispanic (n=22; 18%), Asian Pacific Islander (API) (n=8; 6%), non-Hispanic black (NHB) (n=8; 6%) and unspecified/other race (n=13; 10%). Hispanic patients had a 3-fold increase in the hazard of death (HR 3.21; 95% CI (2.00-5.17)) when compared to NHW patients. Education and income decreased the hazard of death for Hispanic compared to NHW patients (HR 2.33 95% CI (1.21-4.48)). Insurance status further reduced this disparity (HR 2.02 95% CI (1.01-4.04)). Further adjustment for occupation and household ownership completely neutralized these disparities (HR 1.14; 95% CI (0.52-2.41)). AML: The sample included 67% NHW (n=311) patients; 7% Hispanic (n =31), 5% NHB (n=22), 6% API (n=29) and 15% patients with unspecified/other race (n=68). Similar to ALL, there was a significant association between Hispanic ethnicity and increase hazard of mortality (HR 1.50; 95% CI (1.06-2.11)). There was a marked decreased hazard of mortality associated with API (HR 0.64 95% CI (0.44-0.91)) compared with NHW patients. The results in models adjusted for select SES factors demonstrated a persistent, unchanged mortality disparity for Hispanic patients. Conclusions: SES factors explain some proportion of disparities in acute leukemia mortality, with the most impact in ALL; however, SES factors do not have as strong of an association in AML. Future interventions should be attentive to the underlying and specific factors that can reduce disparities in these diseases. Disclosures No relevant conflicts of interest to declare.

Description: Abstract 2061 Background: Disparities in Acute myelogenous leukemia (AML) have been described but not studied extensively in adults. Younger age at diagnosis and cytogenetic profiles of t(8;21) and acute promyelocytic leukemia (APL) subtypes of AML have been associated with improved survival from AML but no studies to date have evaluated these factors by race. The purpose of the current study is to evaluate differences by race/ethnicity in age and select cytogenetic factors at diagnosis. The hypothesis is that disparities for minorities will be explained by older age at diagnosis and lower rates of select favorable cytogenetics. Methods: Patients with AML were identified in the Surveillance Epidemiology End Results (SEER) database during the years 1999–2008. Kaplan-Meier survival curves were generated to predict survival by race/ethnicity, stratified by age. Multivariable Cox proportional hazard models estimated mortality by race with adjustment for age, gender, year of diagnosis, t(8;21) and APL subtypes. Results: A total of 27,252 patients were included in the study. Blacks and Hispanics were diagnosed at younger ages (