Social determinants of health as a primary driver in outcomes in acute myeloid leukemia: An urban academic center experience.

Abstract

e18659 Background: Healthcare disparities are pervasive in the treatment of cancer. Black patients with acute myeloid leukemia (AML) have shorter survival and inferior outcomes compared to White patients. Lack of insurance coverage decreases survival further. However, outcomes with respect to individual chemotherapy regimens remain unclear. Methods: We analyzed 306 patients with untreated AML that received front-line induction with an anthracycline and cytarabine (7+3) at VCU Massey Cancer Center between January 1, 2013 and January 1, 2022 in this single-center, retrospective analysis. We stratified patients into two cohorts: those that had private insurance or Medicare and those that had no insurance or Medicaid. We recorded baseline demographics, performance status, disease characteristics, response, receipt of allogeneic stem cell transplant (alloSCT), and survival. Patients who were alive at the end of the study period or were lost to follow-up were censored at the date of last contact. Results: There were 243 patients with private insurance or Medicare (Pi/M) and 63 patients with no insurance or Medicaid (Ni/M). The median age was 60 years (range, 18-77) in the Pi/M cohort and 52 years (range, 22-71) in the Ni/M cohort ( p < 0.001). Most patients with private insurance or Medicare tended to be White (72.7% for Pi/M versus 36.1% for Ni/M, p < 0.0001). There were no differences in sex (p = 0.778), the median ECOG score (1 versus 1, p = 0.096), or the median CCI score (4 versus 3, p = 0.607). There were no differences in the distribution of ELN 2017 risk, secondary AML ( p = 0.619), or procession to alloSCT ( p = 0.145). There was no difference in the composite complete remission (CRc; CR + CRi) rate between the Pi/M [44.5% (95% CI, 38.5-51.0)] and Ni/M cohorts (52.6% [95% CI, 39.9-65.0], p = 0.301). The median overall survival significantly favored the patients with private insurance or Medicare (21.7 months versus 15.2 months; log-rank, p = 0.030). Conclusions: AML patients with Medicaid or without insurance tend to be younger minorities. Despite no difference in fitness, disease characteristics, or even response to first-line chemotherapy, the median overall survival significantly favors patients with private insurance or Medicare. Our data clearly illustrates the primary role of social determinants of health in overall outcomes. Policymakers and physicians should push for improved access to care and more affordable insurance coverage. [Table: see text]