Non-Hispanic Black (NHB) and Hispanic patients with acute myeloid leukemia (AML) have higher mortality rates than non-Hispanic White (NHW) patients despite more favorable genetics and younger age. A discrete survival analysis was performed on 822 adult patients with AML from 6 urban cancer centers and revealed inferior survival among 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 compared with NHW patients. A multilevel analysis of disparities was then conducted to investigate the contribution of neighborhood measures of structural racism on racial/ethnic differences in survival. Census tract disadvantage and affluence scores were individually calculated. Mediation analysis of hazard of leukemia death between groups was examined across 6 composite variables: 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. Strikingly, census tract measures accounted for nearly all of the NHB-NHW and Hispanic-NHW disparity in leukemia death. Treatment patterns, including induction intensity and allogeneic transplant, and treatment complications, as assessed by ICU admission during induction chemotherapy, were additional mediators of survival disparities in AML. This is the first study to formally test mediators for observed disparities in AML survival and highlights the need to investigate the mechanisms by which structural racism interacts with known prognostic and treatment factors to influence leukemia outcomes.

中文翻译：

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结构性种族主义是急性髓系白血病结局差异的一个中介因素。

非西班牙裔黑人 (NHB) 和西班牙裔急性髓系白血病 (AML) 患者的死亡率高于非西班牙裔白人 (NHW) 患者，尽管其基因更为有利且年龄较小。对来自 6 个城市癌症中心的 822 名 AML 成年患者进行了离散生存分析，结果显示 NHB（风险比 [HR] = 1.59；95% 置信区间 [CI]：1.15, 2.22）和西班牙裔（HR = 1.25）的生存率较低; 95% CI: 0.88, 1.79) 患者与 NHW 患者相比。然后对差异进行多层次分析，以调查结构性种族主义的邻里措施对种族/民族生存差异的贡献。人口普查区劣势分数和富裕分数是单独计算的。对 6 个复合变量进行了组间白血病死亡风险的中介分析：结构性种族主义（人口普查区劣势、富裕和隔离）、肿瘤生物学（欧洲白血病网络风险和继发性白血病）、医疗保健可及性（保险和临床试验注册） ）、合并症、治疗模式（诱导强度和移植利用率）以及诱导化疗期间入住重症监护病房（ICU）。引人注目的是，人口普查措施几乎解释了所有 NHB-NHW 和西班牙裔-NHW 在白血病死亡方面的差异。治疗模式（包括诱导强度和同种异体移植）以及治疗并发症（根据诱导化疗期间入住 ICU 进行评估）是 AML 生存差异的其他调节因素。这是第一项正式测试调节剂以观察观察到的 AML 生存差异的研究，并强调需要研究结构性种族主义与已知预后和治疗因素相互作用以影响白血病结果的机制。