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

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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 languageEnglish (US)
Pages (from-to)2212-2226
Number of pages15
Issue number14
StatePublished - Apr 7 2022

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology


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