Average Annual Household Research Articles

Household carbon emission differences and their driving factors in Northwestern China

Based on interview survey data, we used the 2006 IPCC Guidelines for National Greenhouse Gas Inventories, the Peoples Republic of China National Greenhouse Gas Inventory(2007), input-output analysis, and life cycle assessment methodology to assess household CO2 emissions in Northwestern China. The result revealed the status and patterns of household CO2 emissions in this area: (1) average annual household CO2 emission per capita is 2.05 tons CO2 per year; (2) the majority of household CO2 emissions came from coal, electricity and food consumption, in which direct CO2 emissions (related to consumption of fossil fuel) accounted for 39.29 percent, and indirect emissions comprised 60.71 percent; (3) household CO2 emission was mainly affected by geographic environment, family size and income, and household age structure; (4) amounts, sources and driving factors of CO2 emission varied between urban and rural households, as well as between households in different provinces.

Direct economic burden of hepatitis B virus related diseases: evidence from Shandong, China

BackgroundAlthough the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease.MethodsFrom April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China.ResultsOur data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was $2954, $10834, $4552, $7400.28, $6936 and $10635, respectively. These costs ranged from 30.72% (for acute hepatitis B) to 297.85% (for primary liver cancer) of the average annual household income in our sample. Even for patients with health insurance, direct out-of-pocket cost of all HBV-related diseases except acute hepatitis B exceeded 40.00% of the patient’s disposable household income, making it a catastrophic expenditure for the household.ConclusionHepatitis B imposes considerable economic burden on a family. Our findings will help health policy makers’ understanding of the magnitude of the economic burden of HBV-related diseases in China. Evidence from our study also contributes to our understanding of potential benefits to society from allocating more resources to preventing and treating HBV infection, as well as increasing insurance coverage in China. These findings have important policy implications for health care reform efforts currently underway in China focusing on how to reduce the burden of catastrophic disease for its citizens.

Ecological and Socio-Economic Contribution of Mt. Elgon Forest Park, Eastern Uganda

This paper explores the ecological and socio-economic contribution of Mt. Elgon forest park, eastern Uganda. An effort was taken to evaluate the importance of Mt. Elgon forest park resources to the local people by using the local plant knowledge to value the forest park resources. An integrated approach of participatory rural appraisal (PRA), Participatory Resource Valuation (PRV), household survey, group discussions and forest walks were conducted during the months of June to December, 2008 in Mutushet and Kortek Parishes, Kapchorwa District. Using random sampling methods, 120 respondents were selected and interviewed. Ten forest uses were identified with the highest dependence being in the supply of timber for income and domestic building poles, the latter having the highest average annual household value of UGx. 67919 (US$37). The forest use most valued in both Mutushet and Koterk was medicine with an average annual household value of UGx. 60,371 (US$ 33) and UGx. 75,464 (US$ 42) respectively. The forest provision of medicine, domestic building materials, soil conservation, bush meat, charcoal and timber was more valued in Koterk, while provision of firewood, honey and pasture were more valued in Mutushet. The forest’s provision of food was valued equally in the two areas with an average annual value of UGx. 30,186 per household. Forest park resources accounted for 55% of the household income. Participatory valuation approaches are ecommended for estimation of forest park resources’ value in a non-cash economy.

Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines

OBJECTIVE The National Health Insurance Program (NHIP) in the Philippines is a social health insurance system partially subsidized by tax-based financing which offers benefits on a fee-for-service basis up to a fixed ceiling. This paper quantifies the extent to which beneficiaries of the NHIP incur out-of-pocket expenses for inpatient care, and examines the characteristics of beneficiaries making these payments and the hospitals in which these payments are typically made. METHODS Probit and ordinary least squares regression analyses were carried out on 94 531 insurance claims from Benguet province and Baguio city during the period 2007 to 2009. RESULTS Eighty-six per cent of claims involved an out-of-pocket payment. The median figure for out-of-pocket payments was Philippine Pesos (PHP) 3016 (US$67), with this figure varying widely [inter-quartile range (IQR): PHP 9393 (US$209)]. Thirteen per cent of claims involved very large out-of-pocket payments exceeding PHP 19 213 (US$428)-the equivalent of 10% of the average annual household income in the region. Membership type, disease severity, age and residential location of the patient, length of hospitalization, and ownership and level of the hospital were all significantly associated with making out-of-pocket payments and/or the size of these payments. CONCLUSION Although the current NHIP reduces the size of out-of-pocket payments, NHIP beneficiaries are not completely free from the risk of large out-of-pocket payments (as the size of these payments varies widely and can be extremely large), despite NHIP's attempts to mitigate this by setting different benefit ceilings based on the level of the hospital and the severity of the disease. To reduce these large out-of-pocket payments and to increase financial risk protection further, it is essential to ensure more investment for health from social health insurance and/or tax-based government funding as well as shifting the provider payment mechanism from a fee-for-service to a case-based payment method (which up until now has only been partially implemented).

Environmental Changes and the Onset of Inflammatory Bowel Disease (IBD) in the Migrant South Asian Population

Purpose: The increase in the incidence of IBD in South Asian patients over the past 2 decades has been attributed to both genetic and environmental factors. A comprehensive evaluation of hygiene and dietary changes among the Indian diaspora to the U.S. has never been conducted. Methods: In this pilot study, we administered a questionnaire to first generation Indian immigrants with IBD in Northern California. The questions were extensive and involved changes in diet, stress, hygiene and lifestyle after immigration from India to the U.S.A. Results: Twenty patients are enrolled to date. 12 ulcerative colitis (UC) patients and 8 Crohn's disease (CD) patients were surveyed. Average number of years since migrating to the United States was 22.5 years (11-50 years). Average number of years from time of migration to time of diagnosis was 11.9 years (3-40 years) Average age at diagnosis was 35 years (17-68 years). Significant dietary changes were noted upon immigration. These include increase in animal protein and fat intake, the consumption of pasteurized milk, adoption of a more western diet instead of traditional Indian diet, decreased consumption of freshly prepared foods, consistent daily use of the microwave and the consumption of pre-prepared or packaged foods (Table 1). 25% of UC and 12.5% of CD patients had ever smoked. 50% UC and 62.5% of the CD patients consumed any alcohol. Environmental changes include access to running hot water, switch to the use of toilet paper instead of water, appropriate hand washing techniques and use of hand sanitizer (Table 2). Life style changes included increased perceived stress which was seen in 83.3% UC and 87.5% CD patients. 95% of all patients surveyed came from a lower socioeconomic status prior to migrating to the U.S. with annual household incomes below $20,000. However, upon migration 85% had average annual household incomes above $80,000. 58.3% UC and 75 % of CD patients had no refrigerator while growing up in India. Improved oral hygiene was observed in 50% of UC and 87.5% CD patients. 41.6 %UC patients and 50% CD patients had a family history of IBD. However, in all affected family members, the symptoms and diagnosis of IBD occurred only after migration to the U.S. Conclusion: South Asian immigrants with IBD note a significant change in diet, hygiene and lifestyle after arrival in the US. Further studies will be done to compare these patients to non-IBD migrant controls and to determine microbiome variations with immigration and disease onset.

On the dynamics of interstate migration: Migration costs and self-selection

This paper develops a dynamic structural model of migration decisions that is aggregated to describe the behavior of interregional migration. Our structural approach allows us to deal with dynamic self-selection problems that arise from the endogeneity of location choice and the persistence of migration incentives. The self-selection problem is solved by keeping track of the distribution of migration incentives over time. This econometric treatment has important consequences for the estimation of structural parameters such as migration costs. For US interstate migration, we obtain a cost estimate of roughly two-thirds of an average annual household income. We also show that the treatment of income persistence has important consequences for comparative statics of the model as well as microeconomic age patterns of migration.

Common property forest resources and rural livelihoods: an empirical investigation in the state of Odisha

A vast majority of India's 700 million plus rural population,and most of the 30 million population of Odisha, living in its villages, are critically dependent on Common Property Resources (CPRs) for earning their livelihood. In this backdrop, the paper has made an attempt to study the degree, extent, and determinants of common property forest resource dependency at a household level in the villages of Odisha. The field survey results suggest that income from common property forests constitutes 30.97% of the Common property forest dependency in Odisha total average annual household income. For the poorest 10% of the Objectives, database, and sample households, CPR forest income constitutes 58.70% of their total methodology annual income and for the richest 10% the same has been estimated Empirical findings at 12.88%. Multivariate regression analysis reveals that CPR forest dependency is directly related to household size but inversely related to economic condition and agricultural land holding.

Postpartum depression: the distribution of severity in a community sample

Dear Editor, The prevalence of postpartum depression (PPD) is well established by a wealth of epidemiological studies (Gavin et al. 2005). Nevertheless, because PPD status is often dichotomous and based on DSM-IV criteria for major depressive disorder (MDD) or on an established cutoff score, little is known about the variation in symptom severity among those diagnosed as depressed. Accounting for variation in severity levels among depressed women would not only inform treatment referrals, but would also improve specificity in the identification of research participants for treatment trials and may more accurately account for differential treatment responses. To describe variation in depression severity in a sample of clinically depressed women, we analyzed a previously collected data set (O'Hara et al. 2000) with demographic and diagnostic data from 292 women who were recruited for a treatment trial. The data reflect pretreatment depression status. Demographically, these women were predominantly white (96.9%, n=283), non-Hispanic (97.9%, n=286), and married (87.7%, n=256,) with an average age of 28.4 years. Over half (59.9%, n=175) were employed with an average annual household income of approximately US $40,200 and average educational level of 14.6 years. All women were diagnosed with MDD according to the Structured Clinical Interview for DSM-IV Disorders (SCID); women with minor depression were not included in the data set. Scores on the Hamilton Rating Scale for Depression (HRSD) were available for each woman. Using five previously established levels of depression severity based on HRSD scores (Furukawa et al. 2007), we calculated the frequency of depressed women at each severity level. These severity levels have been defined as “level 1—normal/no illness” (HRSD 0–3), “level 2—borderline ill” (HRSD 4–7), “level 3—mildly ill” (HRSD 8–15), “level 4—moderately ill” (HRSD 16–26), and “level 5—severely ill” (HRSD 27–50). The results indicate that even within a clinically depressed sample of women, there is a wide range of depression severity (Table 1). Noteworthy are the 5% of women who were diagnosed with MDD based on the SCID, yet received low HRSD scores. One explanation for this discrepancy is that the SCID and HRSD assess slightly different time periods; the SCID assesses the worst 2 weeks in the last month while the HRSD assesses the past week. Table 1 Prevalence of postpartum depression by severity level These results have important treatment and research implications. From a stepped care model perspective, depressed women with symptoms in the mild range may require less intensive treatment, such as a support group, while depressed women with more severe symptoms may require more aggressive treatment, like therapy or medication. Tailored treatment plans for women suffering from different severity levels of PPD have the potential to be efficient in terms of both time and cost. These results are also potentially informative for clinical research where treatments might have differential efficacy based on depressive severity level. Future treatment trials might examine outcome based on clusters of depression severity to better account for variation in treatment response. Although these results are not surprising, to our knowledge, this is the first study to analyze the frequency of PPD by severity level. Admittedly, the data set of the present analysis is homogenous in terms of both ethnicity and marital status, so it would be valuable for future studies to examine varying severities of PDD in a more diverse sample. In conclusion, given the aforementioned treatment and research benefits of identifying clinically depressed women by severity level, it is hoped that clinicians and researchers will consider this factor in the future.

Psychological well-being and reactions to multiple unemployment events: adaptation or sensitisation?

BackgroundUnemployment has been negatively associated with psychological well-being. This study examines the effect of multiple unemployment spells, specifically whether people become sensitised or adapt to unemployment if they are previously...

The Contribution of Forest Products to Dryland Household Economy: The case of Kiang’ombe hill forest, Kenya

An integrated approach of participatory rural appraisal (PRA), participatory environmental valuation (PEV), household survey, group discussions and forest walks with knowledgeable people was used in an ethnobotanical survey of Kiang’ombe hill forest in Mbeere District of Kenya. Ten forest uses were identified with the highest dependence being in the supply of building materials and medicine, the latter having the highest average annual household value of KSh. 2953 (US$47). The average annual household forest value was calculated at KSh. 16,175.6 (US$256.80), accounting for 55.4% of household income. Use of PEV in Kiang’ombe, where there were no formal records of forest use, was important in assigning monetary value to biodiversity elements essential for survival that were assumed to be free for the taking. The assigned monetary value gives weight to otherwise non-monetary values recognized by local communities but ignored because they do not enter formal markets. PEV is one of the recommended methods for estimation of forest resources’ value in a non-cash economy.

Case Study of Motorcycle Use and Policy Analysis in Huizhou, China

This paper analyzes the motorcycle usage and policies in Huizhou, China. Two sets of survey data were used in the study: one is Daily Trip Survey of Huizhou that was taken in 2004, and the other one is Resident Travel Preference and Behavior Survey of Huizhou that was taken in 2006. It was found that men are more likely than women to use motorcycles. The average annual household income for motorcycle users is less than for car users but higher than bike and transit users. Two types of motorcycle policies (active policies and passive policies) are considered in the study. Approximately 50% of motorcycle users would be willing to switch to transit if corresponding active policies were in operation. However, if only passive policies were in operation, approximately 7% of motorcycle users would be willing to switch to driving a car. So, to lead motorcycle users to switch to more sustainable travel mode, a group of policies should be used in Huizhou instead of a single policy forbidding motorcycle use.

SOCIO-ECONOMIC IMPORTANCE OF GUM AND RESIN RESOURCES IN THE DRY WOODLANDS OF BORANA, SOUTHERN ETHIOPIA

ABSTRACT Drylands of Borana Zone, southern Ethiopia, are endowed with different woody species that produce commercial gums and resins, which support the Livelihoods of pastoral and agro-pastoral communities. The objectives of this study were to: (i) assess the role of gum and resin production and marketing in the livelihoods of the pastoral and agro-pastoral communities; (ii) identify major challenges and constraints that hinder sustainable production; (iii) analyze the existing opportunities related to future gum and resin production and commercialization; and (iv) understand the perception of the local communities and the overall future prospects of sustainable gum and resin development, production and commercialization. A semi-structured questionnaire was administered to a total of 80 households, randomly selected from two representative Districts (Arero and Yabello) in the Borana Zone. Group disscussions were also held with 12 key informants. Additional information was also collected from District and Zonal officials, local merchants and enterprises engaged in businesses involving gums and resins. The results revealed that the pastoral and agro-pastoral communities in Borana Zone have intimate attachments with the woody species that provide gums and resins, and that collection and marketing of gums and resins are among the three major sources of livelihoods of local communities, along with livestock and crop production. The average annual household income generated from the sale of gums and resins was estimated at about 2,674 and 2,403 Ethiopian Birr (about 311.00 and 279.00 USD) at Arero and Yabello, respectively. Collection and sale of gums and resins represented the sole source of income for the disadvantaged groups in the local communities, i.e. women, school children and poor households with neither livestock nor land resources. The majority of respondents identified the income generated from the sale of gums and resins as a safety-net safeguarding the communities during recurrent drought periods. Gums and resins are also sources of food, chewing gum, traditional medicine, fodder, traditional soap, insect repellents, fragrance for smoking houses and other cultural practices. Several challenges and constraints are discussed, which affect the sustainable use of the vast woodlands for enhanced livelihoods and reduced household vulnerability in Borana.

Status and socio-economic significance of wetland in the tropics: a study from Bangladesh

This study was carried out in the adjacent communities of the Hakaluki haor, the largest inland freshwater wetland of Bangladesh to explore their socio-economic status and haor-based livelihood dependency. Hakaluki haor is a poverty stricken region with 37% households falling into extreme poor group having monthly income of Tk 2 000.00 only. More than half of the community view Hakaluki haor as the vital source of livelihoods. The surrounding community is dependent on the haor in varying degree (15% totally dependent, 32% moderately and 53% less) with a variety of livelihood activities like fishing and related profession (32%), duck rearing (29%), cattle rearing (28%), fuel wood collection (6%), sand extraction (3%) and reed collection (2%). The average annual household incomes from fishing of naturally available fish, pisciculture and NTFPs collection are Tk 21 701.35, Tk 31 524.83 and Tk 2 704.80, respectively. The haor serves as the source of fuel for cooking to a majority of the community (48%). The respondents identified over-exploitation of fish resources, use of excessive pesticides and gradual increase of human settlement in and around the haor as the most threatened events. With the designation as Ecologically Critical Area (ECA) by the government, immediate attempts should be taken to ensure sustainable utilization of the haor resources. Development of integrated management plan with a provision of the participation of local stakeholders may become the possible way of conserving this wetland.This study was carried out in the adjacent communities of the Hakaluki haor, the largest inland freshwater wetland of Bangladesh to explore their socio-economic status and haor-based livelihood dependency. Hakaluki haor is a poverty stricken region with 37% households falling into extreme poor group having monthly income of Tk 2 000.00 only. More than half of the community view Hakaluki haor as the vital source of livelihoods. The surrounding community is dependent on the haor in varying degree (15% totally dependent, 32% moderately and 53% less) with a variety of livelihood activities like fishing and related profession (32%), duck rearing (29%), cattle rearing (28%), fuel wood collection (6%), sand extraction (3%) and reed collection (2%). The average annual household incomes from fishing of naturally available fish, pisciculture and NTFPs collection are Tk 21 701.35, Tk 31 524.83 and Tk 2 704.80, respectively. The haor serves as the source of fuel for cooking to a majority of the community (48%). The respondents identified over-exploitation of fish resources, use of excessive pesticides and gradual increase of human settlement in and around the haor as the most threatened events. With the designation as Ecologically Critical Area (ECA) by the government, immediate attempts should be taken to ensure sustainable utilization of the haor resources. Development of integrated management plan with a provision of the participation of local stakeholders may become the possible way of conserving this wetland.

A Health Survey of a Colonia Located on the West Texas, US/Mexico Border

Little is known about how health disparities affect the health status and general health perceptions of Hispanics living in Texas colonias. The purpose of this study was to conduct a health survey of residents (n = 216) of a colonia community on the border between El Paso, Texas and Juarez, Mexico. Instruments used in this study included a researcher developed demographic questionnaire, the Short Acculturation Scale for Hispanics (SASH), Cutting down, Annoyance by criticism, Guilty feeling and Eye-openers (CAGE) for alcohol consumption, and the Short Form version 2 (SF36v2) health survey. Study findings show the average participant was approximately 42 years old, attained an average of 9.6 years of education, earned an average annual household income of $17,575 and had an average SASH score of 25.4. SASH scores range from 12 to 60, with higher scores suggesting higher levels of American acculturation. Findings from this health survey suggest the average resident of the colonia may have health disadvantages when compared to residents from other parts of El Paso and Texas. Binge drinking was self-reported by 13.4% of all participants; with 5.6% having a CAGE score greater than 2 (indicating an increased propensity towards problems with alcohol). The self-report rates of diabetes, depression and anxiety were 15.3%, 20.4% and 16.7% respectively. The SF36v2 composite functional health status scores mirrored the national norms.

A preliminary survey of household and personal carbon dioxide emissions in Ireland

A model specifically designed for Ireland was used to measure CO 2e emissions (CO 2, CH 4 and N 2O) from Irish households for the first time. A total of 103 Irish households with occupancy rates varying between 1 and 6 (mean 2.9) were surveyed. The average annual household emission was found to be 16.55 t CO 2e y − 1 , which is equivalent to an average personal emission of 5.70 t CO 2e Ca − 1 y − 1 comprising 42.2% related to home energy use, 35.1% to transport, 20.6% to air travel and other fuel intensive leisure activities, and just 2.1% associated with household waste disposal. Air travel accounts for an average personal emission of 1.152 t CO 2e Ca − 1 y − 1 , although this is highest in single and two person households at 1.693 and 2.227 t CO 2e Ca − 1 y − 1 respectively. Household energy consumption becomes more efficient when occupancy rate increases. The most energy efficient homes in the survey were terraced with a natural gas heating systems. The least efficient were detached house with oil fuelled heating system.

On the Dynamics of Interstate Migration: Migration Costs and Self-Selection

This paper develops a tractable dynamic microeconomic model of migration decisions that is aggregated to describe the behavior of interregional migration. Our structural approach allows us to deal with dynamic self-selection problems that arise from the endogeneity of location choice and the persistency of migration incentives. Keeping track to the distribution of migration incentives over time has important consequences, because the dynamics of this distribution influences the estimation of structural parameters, such as migration costs. For US interstate migration, we obtain a cost estimate of somewhat less than one-half of an average annual household income. This is substantially less than the migration costs estimated by previous studies. We attribute this difference to the treatment of the dynamic self-selection problem.

Hospital admissions for renal colic in Malta: Economic patterns

Background: Renal colic is a significant phenomenon in secondary medical care. Aims: This study aims to establish if the rate of admission for renal colic differs between districts with differing average annual household income. Method: 519 patients were admitted for renal colic at St Luke's hospital Malta between Jan 2001 and Dec 2004, 485 patients were considered after exclusions. The residential locality of each patient was recorded; data on demographics and average earnings was obtained from the Maltese National Office of Statistics. Results: The overall annual incidence was 32.56 per 10000 persons. Analysis revealed a significant linear relationship between income and incidence of admission for renal colic (P=0.010), with areas of higher income having significantly lower rates of admission, although proper age matching was impossible due to the limited data available. Many confounding factors exist with this method of observation. Better investigation is needed for a definitive explanation.

The economic status of union workers in the United States

Although American labor unions evolved out of poverty, today’s typical union worker is relatively affluent. Current Population Survey data show that average annual household earnings in 2002 for full-time union workers were nearly $79,000, nearly double the median of all households (including ones with non-workers), and more than for nonunion worker households. While relatively few union workers are truly “poor,” a larger proportion (over one-third for members of teachers’ unions) comes from households with over $100,000 in annual income. A puzzle: why do union members tend to support liberal policies and politicians far more than their relative affluence would predict? Perhaps it partly reflects rent-seeking behavior.

Impact of Socioeconomic Status and Distance from Treatment Center on Survival in Patients Receiving Remission Induction Therapy for Newly Diagnosed Acute Myelogenous Leukemia (AML).

Background: Socioeconomic status (SES) and distance from a treatment center are prognostic factors in chronic malignancies, such as head and neck or breast cancer, where relative disease latency enables patients with greater means to travel to receive their care. Little is known about the influence of these demographics on patient outcomes in rapidly-growing cancers, such as AML.Methods: We conducted a retrospective review of all patients receiving remission induction therapy for AML at the Cleveland Clinic between January 1997 and December 2005. Race and residential zipcodes were obtained from information disclosed by patients in their electronic medical records. Average annual household income in a zipcode and distance from the treatment center were obtained using web-based databases (www.melissadata.com, www.zip-codes.com). Data on known prognostic factors (age, WBC at diagnosis, cytogenetic risk groups (as defined by CALGB 8461) and AML etiology (de novo vs. secondary AML)) were collected and controlled for in multivariable analyses. Survival was estimated using the Kaplan-Meier method, and the association between distance and income assessed using the Spearman rank correlation.Results: Anthracycline-based remission induction chemotherapy was administered to 281 patients: 132 (47%) were female, with a median age at diagnosis of 60 years (range 17–80). Median WBC at diagnosis was 9.9 k/uL (range:0.4–550 k/uL). Cytogenetics were favorable in 33 patients (11.7%, 10 of whom had t(15;17)), intermediate in 137 (48.8%), unfavorable in 73 (26%), and unknown in 38 (13.5%). Ninety patients (32%) had secondary AML. The ethnic distribution was consistent with other AML series: 252 (90.6%) were Caucasian (C), 22 (7.9%) were African American (AA), and 4 (1.4%) were neither (non-AA non-C). The median distance from the treatment center was 24.4 miles (range: 0.9–2058), and median average household income was $38,972 (range: $17,496-$143,220). Overall survival (OS) was 30.2% at a median of 22.6 months of follow-up. There was no significant correlation between distance and income. In both univariable and multivariable analyses, age ≥60 years, unfavorable cytogenetics, increased WBC count at presentation and secondary AML were all found to adversely affect survival (p<0.001, p<0.001, p=0.035, and p=0.010, respectively). OS was similar for AA and non-AA non-C patients compared to C (HR=1.12 [95% CI=.61–2.07, p=.71], and HR=.87 [CI=.21–3.62, p=.84], respectively). Neither distance from treatment facility (HR=1.00 [95%CI = .98–1.02 p =.96] for every 20 mile increase in distance) nor SES (HR=1.02 [95%CI=.92–1.13, p=.77] per $10000 increase) had an impact on OS. Similar findings held for CR rates.Conclusion: Contrary to their impact on chronic malignancies, neither SES nor distance from treatment facility affect outcome in patients with AML treated at the same hospital. This supports referring patients for treatment to tertiary facilities skilled at managing AML, even when they live at great distances from those facilities.

Prognostic Factors and Outcomes of Patients with Acute Myeloid Leukemia (AML) Receiving Non Intensive Chemotherapy (NIC) or Best Supportive Care (BSC).

Background: AML in older adults poses therapeutic challenges, as many patients are not candidates for intensive chemotherapy (IC), and it is not clear that IC provides a survival benefit compared to NIC/BSC. While risk factors and outcomes of patients treated with IC are well-defined, few data support similar prognostication in patients treated with NIC or BSC.Methods: We conducted a retrospective review of all patients with AML receiving NIC or BSC at the Cleveland Clinic between January 1997 and December 2005. NIC consisted of treatment with hydroxyurea, low-dose cytarabine, or azacitidine. The choice and decision of therapy was dictated by patient and physician preferences. Data on known prognostic factors (age, white blood cell count (WBC) at diagnosis, cytogenetic risk groups (as defined by CALGB 8461) and AML etiology (de novo vs. secondary AML)) were collected and controlled for in multivariable analyses, and survival determined using the log-rank test, measured from the time of diagnosis. Race and residential zipcodes were obtained from information disclosed by patients in their electronic medical records. Average annual household income in a zipcode was obtained using a web-based database, www.melissadata.com.Results: Fifty-three patients were identified. The median age was 74 years (range 33–92), and 26 patients (49%) were female. Eight patients (15%) were African American (AA), while 44 patients were Caucasian (C) and 1 patient was neither AA nor C. The median WBC at presentation was 6.0 ×103/μL. Cytogenetics were favorable in 1 patient (2%), intermediate in 10 (19%), unfavorable in 19 (36%), and unknown in 23 (43%). Most patients (60%) had secondary AML. The median average annual income was $39,332 (range 23,375–82,806). The median survival was 54 days (95% CI 33–80 days) for all patients, and the 1 year survival was 7%. Known prognostic factors for AML (WBC at presentation, de novo vs. secondary AML, cytogenetics, and age at diagnosis) were not predictors of overall survival in multivariable analyses in patients not receiving intensive chemotherapy, though higher WBC count was predictive in univariable analyses. Race was a predictor for outcomes, with AA patients experiencing a worse median survival than their C counterparts (22 days versus 64 days, log rank p=0.03, figure 1) despite similar baseline characteristics. SES, however, had no impact on outcome.Conclusions: AML patients receiving NIC or BSC have a median survival of almost 8 weeks, with AA patients experiencing worse outcomes. A small but significant percentage of patients remain alive at one year. Prognostic variables useful in treatment decision-making in patients receiving IC are less valuable for NIC/BSC patients. This information can be used for patient counseling and to help guide treatment decisions. [Display omitted]