Background: Acute Myeloid Leukemia (AML) outcomes are dependent on leukemia-specific factors such as cytogenetics and patient-specific factors, such as age and performance status. However, racial and socioeconomic disparities have become increasingly apparent. We analyzed in-hospital death among AML-related hospitalizations and evaluated for differences in sociodemographic characteristics, focusing on the effect of age and race.
Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2009-2018. We included hospitalizations for adults with a diagnosis of AML based on ICD-9-CM and ICD-10-CM. We categorized patients’ ages in groups of <60 years and ≥ 60 years and stratified them by reported ethnicity. Exposures of interest were patient socio-demographics, hospital characteristics and Elixhauser-comorbidity Index. Outcome of interest was in-hospital death. Statistical analyses included joinpoint regression to assess temporal trends and survey logistic regression to generate adjusted odds ratios (aORs) and 95% Confidence Intervals (CIs) to assess the independent associations between patient characteristics and mortality.
Results: Of 662,417 AML-related hospitalizations, 358,762 (57.6%) were inpatients ≥60 years. The overall rate of in-hospital death was 9.4%. Compared to patients <60, older patients experienced a higher rate of in-hospital death. In both age groups, mortality improved over time. Differences in mortality were observed based on gender, payer, hospital location and teaching status across all ages. For hospitalizations in patients ≥ 60, factors associated with in-hospital death included NH-Black race (OR 1.17; CI 1.08-1.28) and co-morbidities within the elderly Hispanic subgroup.
Conclusions and Global Health Implications: Previous studies have not evaluated racial disparities in the mortality of hospitalized patients with AML. Our results highlight the increased need to recognize the role of race and socioeconomic factors and their contribution to disparate outcomes in AML.
Key words: • Acute Myeloid Leukemia • Hospitalization • Health Disparity • Racial Disparity • HCUP NIS
Copyright © 2021 Alam et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.