Impact of neighborhood archetypes on overall mortality among young patients with acute leukemia in California

Abstract

Introduction

Residence in lower socioeconomic neighborhoods is associated with lower survival in children, adolescents, and young adults with leukemia. We sought to evaluate the impact of neighborhood archetypes on acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) survival.

Methods

Patients aged 0 to 39 years diagnosed with ALL or AML from 2006 through 2016 in the California Cancer Registry were included. Nine-class neighborhood archetypes, generated by latent class analysis of 39 social and built environment attributes at the census tract level, were the primary exposure of interest. Cox proportional hazards models were used for statistical analyses, stratified by age.

Results

Among 8776 patients, 72% had ALL and 28% had AML. For ALL, increased risk of mortality was observed in mixed socioeconomic status suburbs (adjusted hazard ratio, 1.39; 95% CI, 1.06–1.84) and Hispanic small towns (adjusted hazard ratio, 1.33; 95% CI, 1.03–1.84) relative to upper middle-class suburbs. For AML, neighborhood archetypes were not associated with mortality. When stratified by age, we observed associations between neighborhood archetypes (mixed socioeconomic status class suburb, inner city, Hispanic small towns) and mortality in pediatric but not young adult ALL patients.

Conclusions

Our findings demonstrate that neighborhood archetypes efficiently account for complex interactions across social and built environment attributes with leukemia survival. The greater effects of neighborhood archetype in pediatric ALL survival, as compared to AML, may be related to the prolonged, outpatient nature of ALL maintenance therapy and the challenges associated with treatment adherence among patients residing in disadvantaged neighborhoods.