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Structural Racism and Its Impact on Survival Among Patients With AML

By: Joseph Fanelli
Posted: Monday, April 4, 2022

Structural racism—as defined by census tract disadvantages, affluence, and segregation—may be a stronger mediator of survival disparities for patients with acute myeloid leukemia (AML) than molecular features, comorbidities, health-care access, and treatment when comparing Black and Hispanic patients with White patients, according to findings presented in the journal Blood. These census tract variables may account for nearly all survival discrepancies between Black and White patients and Hispanic and White patients with AML, concluded Irum Khan, MD, of the University of Illinois Hospital and Health Sciences System, Chicago, and colleagues.

“With widespread adoption of novel low-intensity therapies, the shift from inpatient to outpatient management of leukemia is placing increasing strain on tenuous social support systems and threatens widening disparities during AML therapy,” the authors stated. “While in its infancy, our work clearly establishes that recognizing and addressing structural racism is likely to contribute significantly to narrowing disparities in leukemia survival.”

In this study, the authors performed a discrete survival analysis on 822 patients from six urban cancer centers in metropolitan Chicago. Minority patients, including Non-Hispanic Black (126 patients), Hispanic (117 patients), and other racial or ethnic groups (82 patients), made up 40% of the study population, whereas 60% of the population was considered Non-Hispanic White (497 patients).

The analysis revealed inferior survival rates among the Hispanic and Black patients compared with White patients. Following these results, the authors conducted a multilevel analysis of disparities to investigate the neighborhood measures of structural racism on racial and ethnic differences. A median analysis included six variables: structured racism, tumor biology, health-care access, comorbidities, treatment patterns, and intensive care unit admission.

“Strikingly,” the authors commented, census tract measures accounted for nearly all the disparities for survival between Black versus White and Hispanic versus White patients. In a baseline model adjusted for age, gender, and diagnosing hospital, the hazard of death because of AML was more than 50% greater for Black patients than for White patients.

Disclosure: The authors reported no conflicts of interest.


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