A new study from the University of Illinois Chicago suggests Black and Hispanic patients with a diagnosis of acute myeloid leukemia (AML) have a higher chance of mortality—59% and 25%, respectively—compared with non-Hispanic white people. The common denominator seems to be structural racism in communities around the greater Chicago area.
The study included Latinxs and Hispanic individuals. The term Latinxs refers to a person from Latin America or of Latin American descent, and Hispanic refers to a person from a Spanish-speaking background.
The Cambridge dictionary defines structural racism as: laws, rules, or official policies in a society that result in and support a continued unfair advantage to some people and unfair or harmful treatment of others based on race.
Doctors say an early detection is crucial for effective treatment, which can be costly. According to the National Institute for Health Care Management (NIHCM), Latinxs are 19% less likely to have access to health insurance. This rate is 2.5 times higher than for white people, who were at 7.5% in 2018.
The study, “Structural Racism is a Mediator of Disparities in Acute Myeloid Leukemia Outcomes,” investigated how social determinants such as access to health insurance and structural violence — reinforced by social, financial, and political systems — have an effect on the long-term survival chances of Black and Hispanic patients.
A lead author of the study, Dr. Irum Khan, associate professor of hematology/oncology in the University of Illinois College of Medicine, said, “This is the first study to integrate individual clinical and disease-specific data with census tract data on the affluence, disadvantage and segregation levels of the neighborhoods where patients live and analyze how these domains interact to influence outcomes for patients with AML.”
The team of researchers analyzed medical records data from 822 patients within ages 18 to over 60 who received a diagnosis of AML between 2012 to 2018 at one of six university-affiliated cancer centers in Chicago.
Specific information included sex, race or ethnicity, age at diagnosis, medical history, health insurance access, and genetic features that could suggest a positive or negative prognosis. Additional data from the U.S. Census helped scientists categorize neighborhoods by level of segregation, affluence, or health access.
A total of 445 males and 377 females were identified as:
- 497 non-Hispanic white
- 126 non-Hispanic Black
- 117 Hispanic
- 82 as other or unknown race
Compared with white patients, Black and Hispanic individuals were more likely to live in communities that have been historically segregated. The sample for this study was designed to represent diverse urban populations.
In terms of medication, data showed Hispanic patients had higher rates of intensive chemotherapy as initial treatment. According to Dr. Khan, “Hispanic and non-Hispanic Black patients had higher rates of treatment complications, measured by intensive care unit admissions during initial chemotherapy — 30% and 27%, respectively, compared with non-Hispanic white patients at 22%. Non-Hispanic Black patients were less likely to undergo a stem cell transplant than white and Hispanic patients.”
High-risk genetic features represented a higher risk of AML for non-Hispanic Black patients, suggesting further study could determine if this is due to environmental exposure in specific disadvantaged communities.
After researches adjusted date for patients’ age, sex, and health care institution they found neighborhood affluence, disadvantage, and segregation were all relevant elements for the survival rates of AML.
“Future studies could evaluate allostatic load measures in AML prognostication. Analogous to molecular tailoring of therapy, measures of structural racism need to be developed as a complementary aspect of personalized leukemia therapy,” the study concluded.
Although advances have been made in the treatment of AML, Dr. Khan emphasized there is a gap in factoring social determinants along with medication in treatment plan.