Abstract C067: Impact of neighborhood socioeconomic status on survival among young patients with acute leukemia in California
Authors: Winestone Lena E , Yang Juan , Lichtensztajn Daphne Y , Abrahao Renata , Keegan Theresa H , Cheng Iona , Gomez Scarlett L , Shariff-Marco Salma 
Published: September 2020

Abstract
Introduction: Among young patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), minority race/ethnicity and lack of health insurance have been associated with lower survival. We sought to evaluate the impact of neighborhood socioeconomic status (nSES) and neighborhood archetype on early mortality and overall survival among patients with ALL and AML in California. We hypothesized that living in low SES neighborhoods will be associated with lower survival among young patients with acute leukemia. Methods: Patients aged 0-39 years reported to the California Cancer Registry with a diagnosis of ALL or AML between 2006 and 2016 were included. Using a previously developed composite measure, nSES quintiles were evaluated as the primary exposure of interest. Latent class analysis was used to generate neighborhood archetypes based on 39 social and built environment attributes at the block group level, which were evaluated as an exploratory exposure. Patients were observed from diagnosis through last available follow up. Cox proportional hazards univariate models were used to estimate crude hazard ratios (HR) for early death (within 60 days following diagnosis) and overall survival (OS). Results: Of the 8761 patients included, 6338 were diagnosed with ALL and 2423 were diagnosed with AML. Median follow up time was 3.2 and 2.1 years, respectively. Minority race/ethnicity, older age (&gt;19 years), lack of insurance, lack of chemotherapy, and treatment at an adult center were associated with lower OS in univariate models. Patients in the lowest quintile of nSES had an increased risk of early mortality for both ALL (HR 1.91, 95% CI 1.06, 3.47) and AML (HR 2.01, 95% CI 1.17, 3.45) relative to the highest quintile of nSES. Likewise, patients in the lowest quintile of nSES had lower OS for both ALL (HR 2.10, 95% CI 1.68, 2.62) and AML (HR 1.40, 95% CI 1.12, 1.76). A dose effect was observed with worse OS observed among quintiles 2-4 as well. In patients with ALL, relative to the highest status neighborhood archetype, all other neighborhood archetypes demonstrated lower OS, with the most pronounced effects in inner city (HR 2.35, 95% CI 1.79, 3.09), Hispanic small towns (HR 2.33, 95% CI 1.74, 3.11), and mixed SES class suburban neighborhoods (HR 2.27, 95% CI 1.65, 3.12). While there was a suggestion of differences by archetype among AML patients, none reached statistical significance. Conclusions: The substantial crude effect of neighborhood SES on early mortality and overall survival highlights an important disparity. Multivariable adjustment for other known predictors of survival is underway. When other aspects of the social/built environment are incorporated, the magnitude of the effect grows, suggesting that nSES interacts with other neighborhood factors such as the racial/ethnic makeup. The greater effects of neighborhood among ALL patients relative to AML patients may be linked to the prolonged, outpatient nature of the therapy and difficulties with treatment adherence among vulnerable populations.
Citation Format: Lena E Winestone, Juan Yang, Daphne Y Lichtensztajn, Renata Abrahao, Theresa H Keegan, Iona Cheng, Scarlett L Gomez, Salma Shariff-Marco. Impact of neighborhood socioeconomic status on survival among young patients with acute leukemia in California [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C067.