Purpose Previous US studies have shown that socioeconomic status (SES) affects survival in acute myeloid leukemia (AML). However, no large study has investigated the association between education or income and clinical characteristics, treatment, and outcome in AML. Methods To investigate the effects of education and income in a tax-supported health care system, we conducted a population-based study using individual-level SES and clinical data on all Danish patients with AML (2000 to 2014). We compared treatment intensity, allogeneic transplantation, and response rates by education and income level using logistic regression (odds ratios). We used Cox regression (hazard ratios [HRs]) to compare survival, adjusting for age, sex, SES, and clinical prognostic markers. Results Of 2,992 patients, 1,588 (53.1%) received intensive chemotherapy. Compared with low-education patients, highly educated patients more often received allogeneic transplantation (16.3% v 8.7%). In intensively treated patients younger than 60 years of age, increased mortality was observed in those with lower and medium education (1-year survival, 66.7%; adjusted HR, 1.47; 95% CI, 1.11 to 1.93; and 1-year survival, 67.6%; adjusted HR, 1.55; CI, 1.21 to 1.98, respectively) compared with higher education (1-year survival, 76.9%). Over the study period, 5-year survival improvements were limited to high-education patients (from 39% to 58%), increasing the survival gap between groups. In older patients, low-education patients received less intensive therapy (30% v 48%; adjusted odds ratio, 0.65; CI, 0.44 to 0.98) compared with high-education patients; however, remission rates and survival were not affected in those intensively treated. Income was not associated with therapy intensity, likelihood of complete remission, or survival (high income: adjusted HR, 1.0; medium income: adjusted HR, 0.96; 95% CI, 0.82 to 1.12; low income: adjusted HR, 1.06; CI, .88 to 1.27). Conclusion In a universal health care system, education level, but not income, affects transplantation rates and survival in younger patients with AML. Importantly, recent survival improvement has exclusively benefitted highly educated patients.

中文翻译：

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在税收支持的医疗保健系统中教育和收入对急性髓系白血病患者治疗和结果的影响：一项基于全国人群的队列研究

目的 先前的美国研究表明，社会经济地位 (SES) 会影响急性髓系白血病 (AML) 的存活率。然而，没有大型研究调查过教育或收入与 AML 的临床特征、治疗和结果之间的关联。方法 为了调查教育和收入对税收支持的医疗保健系统的影响，我们使用个体水平的 SES 和所有丹麦 AML 患者（2000 年至 2014 年）的临床数据进行了一项基于人群的研究。我们使用逻辑回归（优势比）比较了教育和收入水平的治疗强度、同种异体移植和反应率。我们使用 Cox 回归（风险比 [HR]）来比较生存率，调整年龄、性别、SES 和临床预后标志物。结果 2992例患者中，1588例（53.1%）接受强化化疗。与受教育程度低的患者相比，受过高等教育的患者接受异基因移植的频率更高（16.3% 对 8.7%）。在 60 岁以下接受强化治疗的患者中，受过中低教育的患者死亡率增加（1 年生存率，66.7%；调整后 HR，1.47；95% CI，1.11 至 1.93；和 1 年生存率， 67.6%；调整后的 HR，1.55；CI，分别为 1.21 至 1.98）与高等教育（1 年生存率，76.9%）相比。在研究期间，5 年生存率的提高仅限于受过高等教育的患者（从 39% 到 58%），这增加了组间生存率的差距。在老年患者中，与受教育程度高的患者相比，受教育程度低的患者接受的强化治疗较少（30% 对 48%；调整后的优势比为 0.65；CI 为 0.44 至 0.98）；然而，那些接受强化治疗的患者的缓解率和生存率没有受到影响。收入与治疗强度、完全缓解的可能性或生存无关（高收入：调整后的 HR，1.0；中等收入：调整后的 HR，0.96；95% CI，0.82 至 1.12；低收入：调整后的 HR，1.06；CI， .88 至 1.27）。结论 在全民医疗保健系统中，受教育程度而非收入会影响年轻 AML 患者的移植率和存活率。重要的是，最近的生存率改善仅使受过高等教育的患者受益。教育水平而非收入会影响年轻 AML 患者的移植率和存活率。重要的是，最近的生存率改善仅使受过高等教育的患者受益。教育水平而非收入会影响年轻 AML 患者的移植率和存活率。重要的是，最近的生存率改善仅使受过高等教育的患者受益。