Lower Neighborhood Socioeconomic Status Is Associated With Intensive Care Unit Admission at Initial Presentation in Children With Acute Leukemia.

Background: Lower socioeconomic status (SES) and minority race and ethnicity are associated with lower overall survival in pediatric leukemia. Higher acuity at initial presentation is associated with mortality during induction chemotherapy. We hypothesized that the mechanism underlying these associations is differences in access to healthcare and that patients who resided in lower SES neighborhoods were more likely to have higher illness acuity at initial presentation compared to patients in higher SES neighborhoods.

Procedure: This retrospective cohort study included patients aged 0-21 diagnosed with acute leukemia and treated at a single institution from 2012 to 2022. Neighborhood SES (nSES) data from the California Neighborhoods Data System were used as a measure of access to care. Laboratory abnormalities indicative of illness acuity and intensive care unit (ICU) admission in the first 72 h of leukemia presentation were collected. Multivariable regression was used to evaluate the association between ICU admission and nSES.

Results: Of 147 patients, 25% required ICU admission within the first 72 h of leukemia presentation. After adjusting for race, ethnicity, insurance, and leukemia risk group, patients in the lowest and middle nSES tertiles were 4.0 times more likely to require ICU admission compared to patients in the highest tertile (confidence interval [CI]: 1.8-9.1).

Conclusions: Children living in lower SES neighborhoods are significantly more likely to require ICU admission at the time of leukemia diagnosis compared to children in higher SES neighborhoods. Interventions focused on improving healthcare access may improve outcomes for groups that have been economically and socially disadvantaged.