ObjectiveExamine the influence of household income on health‐related quality of life (HRQOL) among children with newly diagnosed acute myeloid leukemia (AML).DesignSecondary analysis of data prospectively collected from pediatric patients receiving treatment for AML at 14 hospitals across the United States.ExposureHousehold income was self‐reported on a demographic survey. The examined mediators included the acuity of presentation and treatment toxicity.OutcomeCaregiver proxy reported assessment of patient HRQOL from the Peds QL 4.0 survey.ResultChildren with AML (n = 131) and caregivers were prospectively enrolled to complete PedsQL assessments. HRQOL scores were better for patients in the lowest versus highest income category (mean ± SD: 76.0 ± 14 household income <$25,000 vs. 59.9 ± 17 income ≥$75,000; adjusted mean difference: 11.2, 95% CI: 2.2–20.2). Seven percent of enrolled patients presented with high acuity (ICU‐level care in the first 72 h), and 16% had high toxicity (any ICU‐level care); there were no identifiable differences by income, refuting mediating roles in the association between income and HRQOL. Enrolled patients were less likely to be Black/African American (9.9% vs. 22.2%), more likely to be privately insured (50.4% vs. 40.7%), and more likely to have been treated on a clinical trial (26.7% vs. 18.5%) compared to eligible unenrolled patients not enrolled. Evaluations of potential selection bias on the association between income and HRQOL suggested differences in HRQOL may be smaller than observed or even in the opposing direction.ConclusionsWhile primary analyses suggested lower household income was associated with superior HRQOL, differential participation may have biased these results. Future studies should partner with patients/families to identify strategies for equitable participation in clinical research.

中文翻译：

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接受急性髓系白血病治疗的儿童的家庭收入和与健康相关的生活质量：健康公平研究中选择偏差的潜在影响

目的检查家庭收入对新诊断的急性髓系白血病 (AML) 儿童健康相关生活质量 (HRQOL) 的影响。设计对在美国 14 家医院接受 AML 治疗的儿科患者前瞻性收集的数据进行二次分析。ExposureHousehold收入是根据人口调查自行报告的。检查的中介因素包括表现的敏锐度和治疗毒性。结果护理人员代理报告了 Peds QL 4.0 调查中对患者 HRQOL 的评估。结果患有 AML 的儿童（n= 131）并且前瞻性地招募护理人员来完成 PedSQL 评估。最低收入类别的患者与最高收入类别的患者相比，HRQOL 得分更好（平均值 ± 标准差：76.0 ± 14 家庭收入<25,000 美元 vs. 59.9 ± 17 收入≥75,000 美元；调整后平均差：11.2，95% CI：2.2–20.2）。 7% 的入组患者表现出高敏度（前 72 小时内的 ICU 级别护理），16% 的患者出现高毒性（任何 ICU 级别护理）；收入没有明显的差异，反驳了收入和 HRQOL 之间的中介作用。登记的患者不太可能是黑人/非裔美国人（9.9% vs. 22.2%），更有可能拥有私人保险（50.4% vs. 40.7%），并且更有可能接受过临床试验治疗（26.7% vs. .18.5%）与未入组的合格未入组患者相比。对收入和 HRQOL 之间关联的潜在选择偏差的评估表明，HRQOL 的差异可能小于观察到的差异，甚至相反。结论虽然初步分析表明较低的家庭收入与较高的 HRQOL 相关，但不同的参与可能使这些结果产生偏差。未来的研究应与患者/家属合作，以确定公平参与临床研究的策略。