Early mortality and overall survival of acute myeloid leukemia based on facility type

Vijaya R. Bhatt, Valerie Shostrom, Smith Giri, Krishna Gundabolu, Km Islam, Frederick R. Appelbaum, Lori J. Maness

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Cancer health disparities may exist based on the facility type. We aimed to determine the association between the academic status of centers and outcomes of patients with acute myeloid leukemia (AML). Using the National Cancer Data Base, we compared 1-month mortality and long-term overall survival (OS) of 60 738 patients with AML, who received first course treatment between 2003 and 2011 at academic or nonacademic centers (community cancer program, comprehensive community cancer program, and others). Multivariate analysis was done using logistic regression for one-month mortality and Cox regression with backward elimination approach for OS. Patients treated at academic centers differed from those at nonacademic centers in that they were younger with a median age of 62 versus 70 years (P <.0001), more often an ethnic minority (P <.0001), had lower education level (P =.005), lower co-morbidity score (P <.0001), a different income (P <.0001), and insurance profile (P <.0001), and more often received chemotherapy (P <.0001) and transplant (P <.0001). Receipt of care at nonacademic centers was associated with worse 1-month mortality (29% vs. 16%, P <.0001) and 5-year OS (15% vs. 25%; P <.0001). After adjusting for prognostic covariates, the 1-month mortality (odds ratio, 1.52; 95% confidence interval, CI 1.46-1.59; P <.0001) and OS were significantly worse in nonacademic centers, compared to academic centers. Our large database study suggests that the receipt of initial therapy at academic centers is associated with lower 1-month mortality and higher long-term OS. Investigation of the underlying reasons may allow reducing this disparity.

Original languageEnglish (US)
Pages (from-to)764-771
Number of pages8
JournalAmerican Journal of Hematology
Volume92
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Acute Myeloid Leukemia
Survival
Mortality
Neoplasms
Databases
Insurance
Multivariate Analysis
Logistic Models
Odds Ratio
Confidence Intervals
Morbidity
Transplants
Education
Drug Therapy
Health
Therapeutics

ASJC Scopus subject areas

  • Hematology

Cite this

Bhatt, V. R., Shostrom, V., Giri, S., Gundabolu, K., Islam, K., Appelbaum, F. R., & Maness, L. J. (2017). Early mortality and overall survival of acute myeloid leukemia based on facility type. American Journal of Hematology, 92(8), 764-771. https://doi.org/10.1002/ajh.24767

Early mortality and overall survival of acute myeloid leukemia based on facility type. / Bhatt, Vijaya R.; Shostrom, Valerie; Giri, Smith; Gundabolu, Krishna; Islam, Km; Appelbaum, Frederick R.; Maness, Lori J.

In: American Journal of Hematology, Vol. 92, No. 8, 01.08.2017, p. 764-771.

Research output: Contribution to journalArticle

Bhatt, VR, Shostrom, V, Giri, S, Gundabolu, K, Islam, K, Appelbaum, FR & Maness, LJ 2017, 'Early mortality and overall survival of acute myeloid leukemia based on facility type', American Journal of Hematology, vol. 92, no. 8, pp. 764-771. https://doi.org/10.1002/ajh.24767
Bhatt, Vijaya R. ; Shostrom, Valerie ; Giri, Smith ; Gundabolu, Krishna ; Islam, Km ; Appelbaum, Frederick R. ; Maness, Lori J. / Early mortality and overall survival of acute myeloid leukemia based on facility type. In: American Journal of Hematology. 2017 ; Vol. 92, No. 8. pp. 764-771.
@article{719c787367d44569a62a871dde2433fe,
title = "Early mortality and overall survival of acute myeloid leukemia based on facility type",
abstract = "Cancer health disparities may exist based on the facility type. We aimed to determine the association between the academic status of centers and outcomes of patients with acute myeloid leukemia (AML). Using the National Cancer Data Base, we compared 1-month mortality and long-term overall survival (OS) of 60 738 patients with AML, who received first course treatment between 2003 and 2011 at academic or nonacademic centers (community cancer program, comprehensive community cancer program, and others). Multivariate analysis was done using logistic regression for one-month mortality and Cox regression with backward elimination approach for OS. Patients treated at academic centers differed from those at nonacademic centers in that they were younger with a median age of 62 versus 70 years (P <.0001), more often an ethnic minority (P <.0001), had lower education level (P =.005), lower co-morbidity score (P <.0001), a different income (P <.0001), and insurance profile (P <.0001), and more often received chemotherapy (P <.0001) and transplant (P <.0001). Receipt of care at nonacademic centers was associated with worse 1-month mortality (29{\%} vs. 16{\%}, P <.0001) and 5-year OS (15{\%} vs. 25{\%}; P <.0001). After adjusting for prognostic covariates, the 1-month mortality (odds ratio, 1.52; 95{\%} confidence interval, CI 1.46-1.59; P <.0001) and OS were significantly worse in nonacademic centers, compared to academic centers. Our large database study suggests that the receipt of initial therapy at academic centers is associated with lower 1-month mortality and higher long-term OS. Investigation of the underlying reasons may allow reducing this disparity.",
author = "Bhatt, {Vijaya R.} and Valerie Shostrom and Smith Giri and Krishna Gundabolu and Km Islam and Appelbaum, {Frederick R.} and Maness, {Lori J.}",
year = "2017",
month = "8",
day = "1",
doi = "10.1002/ajh.24767",
language = "English (US)",
volume = "92",
pages = "764--771",
journal = "American Journal of Hematology",
issn = "0361-8609",
publisher = "Wiley-Liss Inc.",
number = "8",

}

TY - JOUR

T1 - Early mortality and overall survival of acute myeloid leukemia based on facility type

AU - Bhatt, Vijaya R.

AU - Shostrom, Valerie

AU - Giri, Smith

AU - Gundabolu, Krishna

AU - Islam, Km

AU - Appelbaum, Frederick R.

AU - Maness, Lori J.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Cancer health disparities may exist based on the facility type. We aimed to determine the association between the academic status of centers and outcomes of patients with acute myeloid leukemia (AML). Using the National Cancer Data Base, we compared 1-month mortality and long-term overall survival (OS) of 60 738 patients with AML, who received first course treatment between 2003 and 2011 at academic or nonacademic centers (community cancer program, comprehensive community cancer program, and others). Multivariate analysis was done using logistic regression for one-month mortality and Cox regression with backward elimination approach for OS. Patients treated at academic centers differed from those at nonacademic centers in that they were younger with a median age of 62 versus 70 years (P <.0001), more often an ethnic minority (P <.0001), had lower education level (P =.005), lower co-morbidity score (P <.0001), a different income (P <.0001), and insurance profile (P <.0001), and more often received chemotherapy (P <.0001) and transplant (P <.0001). Receipt of care at nonacademic centers was associated with worse 1-month mortality (29% vs. 16%, P <.0001) and 5-year OS (15% vs. 25%; P <.0001). After adjusting for prognostic covariates, the 1-month mortality (odds ratio, 1.52; 95% confidence interval, CI 1.46-1.59; P <.0001) and OS were significantly worse in nonacademic centers, compared to academic centers. Our large database study suggests that the receipt of initial therapy at academic centers is associated with lower 1-month mortality and higher long-term OS. Investigation of the underlying reasons may allow reducing this disparity.

AB - Cancer health disparities may exist based on the facility type. We aimed to determine the association between the academic status of centers and outcomes of patients with acute myeloid leukemia (AML). Using the National Cancer Data Base, we compared 1-month mortality and long-term overall survival (OS) of 60 738 patients with AML, who received first course treatment between 2003 and 2011 at academic or nonacademic centers (community cancer program, comprehensive community cancer program, and others). Multivariate analysis was done using logistic regression for one-month mortality and Cox regression with backward elimination approach for OS. Patients treated at academic centers differed from those at nonacademic centers in that they were younger with a median age of 62 versus 70 years (P <.0001), more often an ethnic minority (P <.0001), had lower education level (P =.005), lower co-morbidity score (P <.0001), a different income (P <.0001), and insurance profile (P <.0001), and more often received chemotherapy (P <.0001) and transplant (P <.0001). Receipt of care at nonacademic centers was associated with worse 1-month mortality (29% vs. 16%, P <.0001) and 5-year OS (15% vs. 25%; P <.0001). After adjusting for prognostic covariates, the 1-month mortality (odds ratio, 1.52; 95% confidence interval, CI 1.46-1.59; P <.0001) and OS were significantly worse in nonacademic centers, compared to academic centers. Our large database study suggests that the receipt of initial therapy at academic centers is associated with lower 1-month mortality and higher long-term OS. Investigation of the underlying reasons may allow reducing this disparity.

UR - http://www.scopus.com/inward/record.url?scp=85020125163&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020125163&partnerID=8YFLogxK

U2 - 10.1002/ajh.24767

DO - 10.1002/ajh.24767

M3 - Article

C2 - 28437868

AN - SCOPUS:85020125163

VL - 92

SP - 764

EP - 771

JO - American Journal of Hematology

JF - American Journal of Hematology

SN - 0361-8609

IS - 8

ER -