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.

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.

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).

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.

美国先前的研究表明，社会经济地位（SES）影响急性髓细胞白血病（AML）的生存。但是，没有大型研究调查过教育或收入与AML的临床特征，治疗和结局之间的关联。

为了研究税收支持的医疗保健系统中教育和收入的影响，我们对所有丹麦AML患者（2000年至2014年）进行了一项基于人群的研究，使用了个人一级的SES和临床数据。我们使用逻辑回归（几率）按教育程度和收入水平比较了治疗强度，同种异体移植和缓解率。我们使用Cox回归（危险比[HRs]）来比较生存率，调整年龄，性别，SES和临床预后指标。

在2,992名患者中，有1,588名（53.1％）接受了强化化疗。与低学历的患者相比，高学历的患者更经常接受异体移植（16.3％vs 8.7％）。在年龄小于60岁的接受强化治疗的患者中，受过较低和中等教育的患者的死亡率增加（1年生存率66.7％；调整后的HR为1.47； 95％CI为1.11至1.93； 1年生存率为： 67.6％；调整后的HR为1.55； CI为1.21至1.98，而高等教育水平（1年生存率为76.9％）。在研究期间，只有高学历的患者（从39％到58％）的5年生存率提高受到限制，从而增加了两组之间的生存差距。在高龄患者中，低学历患者接受的强化治疗较少（30％v48％; 调整后的优势比为0.65；CI，0.44至0.98）与高学历患者相比; 但是，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率无关（高收入：调整后的HR，1.0;中收入：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）。

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患者的移植率和生存率。重要的是，最近的生存改善仅使受过良好教育的患者受益。