Despite having better favorable genetics and being younger, non-Hispanic Black (NHB) and Hispanic patients with acute myeloid leukemia (AML) had greater death rates than non-Hispanic White (NHW) patients. A discrete survival study was done on 822 adult patients with AML from six urban cancer centers and indicated that NHB (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.15, 2.22) and Hispanic (HR = 1.25; 95% CI: 0.88, 1.79) patients had lower survival than NHW patients. A multilevel disparities analysis was then carried out to evaluate the impact of local indicators of structural racism on racial/ethnic survival differences. The disadvantage and affluence scores for each census tract were calculated independently. The study looked at how structural racism (census tract disadvantage, affluence, and segregation), tumor biology (European Leukemia Network risk and secondary leukemia), health care access (insurance and clinical trial enrollment), comorbidities, treatment patterns (induction intensity and transplant utilization), and intensive care unit (ICU) admission during induction chemotherapy influenced the risk of leukemia death between groups. Surprisingly, census tract measurements explained virtually all of the NHB-NHW and Hispanic-NHW disparities in leukemia mortality. Treatment patterns, such as induction intensity and allogeneic transplant, as well as treatment problems as measured by ICU hospitalization during induction chemotherapy, were found to be additional mediators of AML survival differences. It was the first study to explicitly evaluate mediators for reported differences in AML survival, highlighting the need to learn more about how structural racism interacts with known prognostic and therapeutic variables to affect leukemia outcomes.
