Predictors of early death and survival among children, adolescents and young adults with acute myeloid leukaemia in California, 1988-2011: a population-based study.
A better understanding of factors associated with early death and survival among children, adolescents and young adults with acute myeloid leukaemia (AML) may guide health policy aimed at improving outcomes in these patients. We examined trends in early death and survival among 3935 patients aged 0-39 years with de novo AML in California during 1988-2011 and investigated the associations between sociodemographic and selected clinical factors and outcomes. Early death declined from 9·7% in 1988-1995 to 7·1% in 2004-2011 (P = 0·062), and survival improved substantially over time. However, 5-year survival was still only 50% (95% confidence interval 47-53%) even in the most recent treatment period (2004-2011). Overall, the main factors associated with poor outcomes were older age at diagnosis, treatment at hospitals not affiliated with National Cancer Institute-designated cancer centres, and black race/ethnicity. For patients diagnosed during 1996-2011, survival was lower among those who lacked health insurance compared to those with public or private insurance. We conclude that mortality after AML remained strikingly high in California and increased with age. Possible strategies to improve outcomes include wider insurance coverage and treatment at specialized cancer centres.
['Abrahão|Renata|R|http://orcid.org/0000-0001-7707-9974', 'Keogh|Ruth H|RH|', 'Lichtensztajn|Daphne Y|DY|', 'Marcos-Gragera|Rafael|R|', 'Medeiros|Bruno C|BC|', 'Coleman|Michel P|MP|', 'Ribeiro|Raul C|RC|', 'Keegan|Theresa H M|TH|']
D000293:Adolescent D000328:Adult D017668:Age of Onset D002140:California D002648:Child D002675:Child, Preschool D004812:Epidemiologic Methods D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D015470:Leukemia, Myeloid, Acute D008297:Male D012959:Socioeconomic Factors D055815:Young Adult
early death survival acute myeloid leukaemia population-based