Chronic Myeloid Leukemia: Impact of Social and Demographic Disparities on Survival Outcomes

Abstract

Introduction: Health disparities disproportionately affect minority populations in the United States across various malignancies. However, the specific impact of race on treatment accessibility and overall survival in chronic myeloid leukemia (CML) remains inadequately characterized. This study investigates the influence of racial and ethnic identities and socioeconomic status on treatment access and survival outcomes in CML patients using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: We conducted a retrospective analysis using SEER data for patients diagnosed with CML between 2000 and 2021. Demographic and treatment characteristics were compared across self-identified racial and ethnic groups (White, Black, Asian or Pacific Islander, and American Indian/Alaska Native). Survival outcomes were assessed using survival time in months and cause of death. Additional variables included median household income (adjusted for inflation), age, sex, ethnicity, race, and urbanicity. Chi-squared tests of independence and odds ratios (ORs) were used to evaluate relationships between these variables and CML outcomes. Results: We identified 10,667 patients diagnosed with CML in our analysis of the SEER database. The racial distribution of the sample was predominantly White (80.51%, N=8,589), followed by Black (10.84%, N=1,157), Asian or Pacific Islander (7.94%, N=847), and American Indian/Alaska Native (0.69%, N=74). Regarding ethnicity, the majority identified as non- Hispanic/Latino (83.68%, N=8,927), while 16.31% (N=1,740) identified as Hispanic/Latino. The highest incidence of CML was observed in the age groups 50-59 years (20.3%) and 60-69 years (19.4%), with most patients residing in urban areas with high-income brackets ($90,000+). Our survival analysis revealed significant disparities across various demographic and socioeconomic factors. Age played a crucial role, with patients over 80 years showing a significantly higher risk of cancer-related death compared to the reference group of 10-19 years (OR: 3.12, 95% CI: 2.76-3.51, p<0.001). Gender also influenced outcomes, with males exhibiting a slightly poorer survival rate than females (OR: 1.15, 95% CI: 1.04-1.27, p=0.045). Racial disparities were evident, as White patients demonstrated the best survival outcomes. In comparison, Asian or Pacific Islander patients had a higher risk of cancer-related death (OR: 1.35, 95% CI: 1.14-1.60, p=0.023), while Black patients showed an even greater risk (OR: 1.55, 95% CI: 1.32-1.82, p=0.018). Other races, including American Indian/Alaska Native, also exhibited elevated risk (OR: 1.45, 95% CI: 1.25-1.68, p=0.018). Socioeconomic status emerged as a significant factor influencing survival outcomes. Patients in high-income brackets (>$100,000) had the best survival rates. Those in middle-income brackets ($50,000-$100,000) showed an increased risk of cancer-related death (OR: 1.75, 95% CI: 1.55- 1.98, p<0.001), while low-income patients (<$50,000) faced the highest risk (OR: 2.05, 95% CI: 1.83-2.30, p<0.001). Interestingly, when adjusted for other variables, ethnicity showed minimal impact on survival (OR: 1.05, 95% CI: 0.95-1.16, p=0.317), suggesting that other factors may play a more significant role in determining CML outcomes than ethnic background alone. Conclusion: Our analysis of CML outcomes using SEER data reveals persistent disparities across demographic and socioeconomic lines, highlighting the complex interplay between social determinants of health and clinical outcomes. The pronounced differences in survival rates among racial groups and socioeconomic strata suggest significant variations in access to specialized care, treatment adherence, and overall healthcare quality. The impact of advanced age on CML outcomes underscores the unique challenges in managing this disease in elderly populations. Interestingly, the minimal impact of ethnicity when adjusted for other variables suggests that socioeconomic factors may play a more crucial role in determining CML outcomes than ethnic background alone.