Effect of Socioeconomic Factors on Survival in Veterans with Acute Myeloid Leukemia (AML)
Authors: Modhia Falgun , Khalil Mohammad O , Mody Ankur D , Johnston Sarah , Zhao Daniel 
Published: October 2019

Abstract
Background:
There is limited information about socioeconomic factors effect on survival in veterans with acute myeloid leukemia (AML). Some studies suggested higher risk of leukemia mortality among veterans who were smokers [1, 2, 3, 4]. Few studies investigated socioeconomic factors like insurance status, care at private or academic center, marital status and median household income effect on outcomes in adults with AML [5, 6, 7].
Methods:
Medical records of AML patients at the Oklahoma City VAHCS between 2010 and 2017 were reviewed. Information collected included home distance from treatment center (≤ 40 miles vs > 40 miles), marital status at diagnosis, tobacco use in the 3 months preceding diagnosis, history of alcohol abuse, level of college education (college education vs less than college education). Fisher-exact test was used for differences in survival rates. Kaplan-Meier analysis was used to estimate the survival and log-rank test to determine differences among groups.
Results:
Total number of Veterans were 28. Fifteen patients (56%) had poor risk disease, 8 (30%) had intermediate risk disease, and 4 (15%) had good risk disease. Median survival for the whole group was 9.3 months. Patients with poor and intermediate risk cytogenetic/molecular status had median survival of 5.5 and 37.7 months, respectively (p=0.0066). There was insufficient number of deaths in the good risk group at the time of this analysis. Median survival for veterans with history of alcohol abuse vs none was 66 vs 7 months (p= 0.15). Median survival for veterans who had some college education vs less than college education was 26.1 vs 6.9, (p=0.14). Median survival for veterans with history of tobacco use within 3 months of diagnosis vs others was 6.9 vs 26.1 (p= 0.11). Median survival for veterans who were married at diagnosis vs non married was 14 vs 7.89 (p=0.29). Median survival for veterans who lived > 40 miles from treatment center vs ≤ 40 miles was 7.43 vs 37.7 months (p=0.5).
Conclusions:
In our retrospective single institute study, poor risk cytogenetic/molecular risk group was associated with inferior survival. While there appeared to be a trend towards worse survival in association with lower education, smoking, non-married status, and longer distance from treatment center, none of these factors had a statistically significant effect. Larger studies are needed to confirm such observations.
References:
1. Austin H, Cole P. Cigarette smoking and leukemia. Journal of chronic diseases. 1986; 39: 417-421.
2. Kahn HA. The Dorn study of smoking and mortality among US veterans: Report on 8.5 years of observation. Bethesda, MD: US Department health, Education and Welfare, 1966; 1-125.
3. Rogot E, Murray JL. Smoking and causes of death among US veterans. 16 years of observation. Public Health Rep. 1980; 95: 213-222.
4. McLaughlin JK, Hrubec Z et al. Cigarette smoking and leukemia. J Natl Cancer Inst 1990; 81: 1262-1263.
5. Luciano Costa, Uma Borate et al. Non Biological factors affecting survival in Younger patients with acute myeloid leukemia. Blood 2014; 124:1273;
6. Gaurav Goyal, Lata Nawal et al. Impact of socioeconomic, demographic and health system factors on therapy in Acute myeloid leukemia. Blood 2015; 126: 3316;
7. Lene Sofie Granfeldt et al, Effects of Education and income on treatment and outcome in patients with AML in tax supported health care system: A national population based cohort study. J Clin Oncol Nov 2017; 35: 3678-3687.

Disclosures
No relevant conflicts of interest to declare.