Racial Disparities in Pediatric Patients With Acute Lymphoblastic Leukemia: An NCDB Analysis

PURPOSE Acute Lymphoblastic Leukemia (ALL) is the most common type of pediatric cancer. The American Cancer Society notes that the risk of ALL is higher in White patients than in Black patients. The goal of this study was to provide an updated investigation of racial disparities in overall survival (OS) of pediatric patients with ALL. METHODS Using the National Cancer Database, this retrospective cohort study identified 23,397 ALL patients between the ages of 0-18 who received chemotherapy from 2004-2020. Patients with race listed as “unknown” or “other” were excluded. Kaplan Meier survival analysis and cox multivariate analysis was used to evaluate OS across race categories. RESULTS OS was 196.8 months 95% confidence interval 195.8 – 197.8 for White patients, 189.7 months 187.6 - 191.8 for Spanish/Hispanic, 182.6 months 179.0 – 186.3 for Black patients, 183.6 months 174.5 to 192.7 for Native American patients, and 192.3 months 188.7 to 195.8 for AAPI patients. Multivariate analysis accommodated for sex, insurance status, median income quartiles, and Charlson-Deyo comorbidity score. Pairwise log rank test revealed Black patients had statistically significantly lower OS compared to White (p < 0.0001) and AAPI patients (p < 0.0001). Black patients had a higher survival hazard ratio compared to White (HR=1.309, 95% CI 1.117 to 1.533, p<0.001). Spanish/Hispanic patients had statistically significant lower OS (p < 0.0001) and higher hazard ratio (HR=1.188, 95% CI 1.058 to 1.334, p = 0.004) compared to non-Spanish/Hispanic patients. 5-year event-free survival (EFS) to be 90.9% for White patients, 87.1% for Black patients, 88.1% for Native American patients, and 92.4% for AAPI patients. CONCLUSION Black patients had decreased OS and greater hazard ratios compared to White patients with ALL. In addition, Hispanic patients had decreased OS and greater hazard ratios compared to non-Hispanic patients. After accommodating for sex, insurance status, median income quartiles, and Charlson-Deyo comorbidity score, we find these racial disparities continue to persist. Reducing the disparities in ALL incidence among pediatric patients from different racial backgrounds is not only a matter of health equity but also a testament to our commitment to ensuring the well-being of all children.