Structural racism is a mediator of disparities in acute myeloid leukemia outcomes

Ivy Elizabeth Abraham; Garth H. Rauscher; Anand Ashwin Patel; William B. Pearse; Priya Rajakumar; Madelyn Burkart; Ahmed Aleem; Ami Dave; Sushma Bharadwaj; Koosha Paydary; Maria Acevedo-Mendez; Krishna Goparaju; Richard Gomez; Kylie Carlson; Stephanie B. Tsai; John G. Quigley; John P. Galvin; Maryam Zia; Melissa L. Larson; Stephanie Berg; Wendy Stock; Jessica K. Altman; Irum Khan

doi:10.1182/blood.2021012830

Structural racism is a mediator of disparities in acute myeloid leukemia outcomes

Ivy Elizabeth Abraham, Garth H. Rauscher, Anand Ashwin Patel, William B. Pearse, Priya Rajakumar, Madelyn Burkart, Ahmed Aleem, Ami Dave, Sushma Bharadwaj, Koosha Paydary, Maria Acevedo-Mendez, Krishna Goparaju, Richard Gomez, Kylie Carlson, Stephanie B. Tsai, John G. Quigley, John P. Galvin, Maryam Zia, Melissa L. Larson, Stephanie BergWendy Stock, Jessica K. Altman, Irum Khan^*

^*Corresponding author for this work

Medicine, Hematology Oncology Division

Research output: Contribution to journal › Article › peer-review

52 Scopus citations

Abstract

Non-Hispanic Black (NHB) and Hispanic patients with acute myeloid leukemia (AML) have higher mortality rates than non-Hispanic White (NHW) patients despite more favorable genetics and younger age. A discrete survival analysis was performed on 822 adult patients with AML from 6 urban cancer centers and revealed inferior survival among NHB (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.15, 2.22) and Hispanic (HR = 1.25; 95% CI: 0.88, 1.79) patients compared with NHW patients. A multilevel analysis of disparities was then conducted to investigate the contribution of neighborhood measures of structural racism on racial/ethnic differences in survival. Census tract disadvantage and affluence scores were individually calculated. Mediation analysis of hazard of leukemia death between groups was examined across 6 composite variables: structural racism (census tract disadvantage, affluence, and segregation), tumor biology (European Leukemia Network risk and secondary leukemia), health care access (insurance and clinical trial enrollment), comorbidities, treatment patterns (induction intensity and transplant utilization), and intensive care unit (ICU) admission during induction chemotherapy. Strikingly, census tract measures accounted for nearly all of the NHB-NHW and Hispanic-NHW disparity in leukemia death. Treatment patterns, including induction intensity and allogeneic transplant, and treatment complications, as assessed by ICU admission during induction chemotherapy, were additional mediators of survival disparities in AML. This is the first study to formally test mediators for observed disparities in AML survival and highlights the need to investigate the mechanisms by which structural racism interacts with known prognostic and treatment factors to influence leukemia outcomes.

Original language	English (US)
Pages (from-to)	2212-2226
Number of pages	15
Journal	Blood
Volume	139
Issue number	14
DOIs	https://doi.org/10.1182/blood.2021012830
State	Published - Apr 7 2022

Funding

This work was funded by the University of Illinois Cancer Center Director's Pilot grant awarded to I.K. and G.H.R. Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Illinois Chicago CCTS and supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1TR002003.

ASJC Scopus subject areas

Biochemistry
Immunology
Hematology
Cell Biology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1182/blood.2021012830

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Abraham, I. E., Rauscher, G. H., Patel, A. A., Pearse, W. B., Rajakumar, P., Burkart, M., Aleem, A., Dave, A., Bharadwaj, S., Paydary, K., Acevedo-Mendez, M., Goparaju, K., Gomez, R., Carlson, K., Tsai, S. B., Quigley, J. G., Galvin, J. P., Zia, M., Larson, M. L., ... Khan, I. (2022). Structural racism is a mediator of disparities in acute myeloid leukemia outcomes. Blood, 139(14), 2212-2226. https://doi.org/10.1182/blood.2021012830

@article{b312c99e1528471d88f506340e417498,

title = "Structural racism is a mediator of disparities in acute myeloid leukemia outcomes",

abstract = "Non-Hispanic Black (NHB) and Hispanic patients with acute myeloid leukemia (AML) have higher mortality rates than non-Hispanic White (NHW) patients despite more favorable genetics and younger age. A discrete survival analysis was performed on 822 adult patients with AML from 6 urban cancer centers and revealed inferior survival among NHB (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.15, 2.22) and Hispanic (HR = 1.25; 95% CI: 0.88, 1.79) patients compared with NHW patients. A multilevel analysis of disparities was then conducted to investigate the contribution of neighborhood measures of structural racism on racial/ethnic differences in survival. Census tract disadvantage and affluence scores were individually calculated. Mediation analysis of hazard of leukemia death between groups was examined across 6 composite variables: structural racism (census tract disadvantage, affluence, and segregation), tumor biology (European Leukemia Network risk and secondary leukemia), health care access (insurance and clinical trial enrollment), comorbidities, treatment patterns (induction intensity and transplant utilization), and intensive care unit (ICU) admission during induction chemotherapy. Strikingly, census tract measures accounted for nearly all of the NHB-NHW and Hispanic-NHW disparity in leukemia death. Treatment patterns, including induction intensity and allogeneic transplant, and treatment complications, as assessed by ICU admission during induction chemotherapy, were additional mediators of survival disparities in AML. This is the first study to formally test mediators for observed disparities in AML survival and highlights the need to investigate the mechanisms by which structural racism interacts with known prognostic and treatment factors to influence leukemia outcomes.",

author = "Abraham, {Ivy Elizabeth} and Rauscher, {Garth H.} and Patel, {Anand Ashwin} and Pearse, {William B.} and Priya Rajakumar and Madelyn Burkart and Ahmed Aleem and Ami Dave and Sushma Bharadwaj and Koosha Paydary and Maria Acevedo-Mendez and Krishna Goparaju and Richard Gomez and Kylie Carlson and Tsai, {Stephanie B.} and Quigley, {John G.} and Galvin, {John P.} and Maryam Zia and Larson, {Melissa L.} and Stephanie Berg and Wendy Stock and Altman, {Jessica K.} and Irum Khan",

note = "Publisher Copyright: {\textcopyright} 2022 American Society of Hematology",

year = "2022",

month = apr,

day = "7",

doi = "10.1182/blood.2021012830",

language = "English (US)",

volume = "139",

pages = "2212--2226",

journal = "Blood",

issn = "0006-4971",

publisher = "Elsevier B.V.",

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Abraham, IE, Rauscher, GH, Patel, AA, Pearse, WB, Rajakumar, P, Burkart, M, Aleem, A, Dave, A, Bharadwaj, S, Paydary, K, Acevedo-Mendez, M, Goparaju, K, Gomez, R, Carlson, K, Tsai, SB, Quigley, JG, Galvin, JP, Zia, M, Larson, ML, Berg, S, Stock, W, Altman, JK & Khan, I 2022, 'Structural racism is a mediator of disparities in acute myeloid leukemia outcomes', Blood, vol. 139, no. 14, pp. 2212-2226. https://doi.org/10.1182/blood.2021012830

TY - JOUR

T1 - Structural racism is a mediator of disparities in acute myeloid leukemia outcomes

AU - Abraham, Ivy Elizabeth

AU - Rauscher, Garth H.

AU - Patel, Anand Ashwin

AU - Pearse, William B.

AU - Rajakumar, Priya

AU - Burkart, Madelyn

AU - Aleem, Ahmed

AU - Dave, Ami

AU - Bharadwaj, Sushma

AU - Paydary, Koosha

AU - Acevedo-Mendez, Maria

AU - Goparaju, Krishna

AU - Gomez, Richard

AU - Carlson, Kylie

AU - Tsai, Stephanie B.

AU - Quigley, John G.

AU - Galvin, John P.

AU - Zia, Maryam

AU - Larson, Melissa L.

AU - Berg, Stephanie

AU - Stock, Wendy

AU - Altman, Jessica K.

AU - Khan, Irum

PY - 2022/4/7

Y1 - 2022/4/7

N2 - Non-Hispanic Black (NHB) and Hispanic patients with acute myeloid leukemia (AML) have higher mortality rates than non-Hispanic White (NHW) patients despite more favorable genetics and younger age. A discrete survival analysis was performed on 822 adult patients with AML from 6 urban cancer centers and revealed inferior survival among NHB (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.15, 2.22) and Hispanic (HR = 1.25; 95% CI: 0.88, 1.79) patients compared with NHW patients. A multilevel analysis of disparities was then conducted to investigate the contribution of neighborhood measures of structural racism on racial/ethnic differences in survival. Census tract disadvantage and affluence scores were individually calculated. Mediation analysis of hazard of leukemia death between groups was examined across 6 composite variables: structural racism (census tract disadvantage, affluence, and segregation), tumor biology (European Leukemia Network risk and secondary leukemia), health care access (insurance and clinical trial enrollment), comorbidities, treatment patterns (induction intensity and transplant utilization), and intensive care unit (ICU) admission during induction chemotherapy. Strikingly, census tract measures accounted for nearly all of the NHB-NHW and Hispanic-NHW disparity in leukemia death. Treatment patterns, including induction intensity and allogeneic transplant, and treatment complications, as assessed by ICU admission during induction chemotherapy, were additional mediators of survival disparities in AML. This is the first study to formally test mediators for observed disparities in AML survival and highlights the need to investigate the mechanisms by which structural racism interacts with known prognostic and treatment factors to influence leukemia outcomes.

AB - Non-Hispanic Black (NHB) and Hispanic patients with acute myeloid leukemia (AML) have higher mortality rates than non-Hispanic White (NHW) patients despite more favorable genetics and younger age. A discrete survival analysis was performed on 822 adult patients with AML from 6 urban cancer centers and revealed inferior survival among NHB (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.15, 2.22) and Hispanic (HR = 1.25; 95% CI: 0.88, 1.79) patients compared with NHW patients. A multilevel analysis of disparities was then conducted to investigate the contribution of neighborhood measures of structural racism on racial/ethnic differences in survival. Census tract disadvantage and affluence scores were individually calculated. Mediation analysis of hazard of leukemia death between groups was examined across 6 composite variables: structural racism (census tract disadvantage, affluence, and segregation), tumor biology (European Leukemia Network risk and secondary leukemia), health care access (insurance and clinical trial enrollment), comorbidities, treatment patterns (induction intensity and transplant utilization), and intensive care unit (ICU) admission during induction chemotherapy. Strikingly, census tract measures accounted for nearly all of the NHB-NHW and Hispanic-NHW disparity in leukemia death. Treatment patterns, including induction intensity and allogeneic transplant, and treatment complications, as assessed by ICU admission during induction chemotherapy, were additional mediators of survival disparities in AML. This is the first study to formally test mediators for observed disparities in AML survival and highlights the need to investigate the mechanisms by which structural racism interacts with known prognostic and treatment factors to influence leukemia outcomes.

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U2 - 10.1182/blood.2021012830

DO - 10.1182/blood.2021012830

M3 - Article

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AN - SCOPUS:85127528203

SN - 0006-4971

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EP - 2226

JO - Blood

JF - Blood

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ER -

Structural racism is a mediator of disparities in acute myeloid leukemia outcomes

Abstract

Funding

ASJC Scopus subject areas

UN SDGs

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