Socioeconomic Deprivation, Lower Hospital Treatment Volume Linked With Poor Survival in ALL


Survival outcomes may be worse for patients with acute lymphoblastic leukemia (ALL) living in intermediate and high socioeconomically deprived areas as well as for those treated in hospitals with lower volumes of patients.

Ravi Maheswaran, MD, University of Sheffield (England) and Nick Morley, MBBS, Royal Hallamshire Hospital (England) conducted a study to examine incidence and survival of patients with ALL in relation to age, gender, socioeconomic deprivation, rurality, and trends over time, as well as a potential association between volume of patients treated by hospitals and survival. National Health Service data on hospital admissions from 2921 adult patients diagnosed with ALL from 2001 through 2012 were analyzed. Researchers assessed follow-up data on survival rates up to 2013.

The study was published in BMC Cancer (online January 4, 2018; doi:10.1186/s12885-017-3975-0).

Socioeconomic deprivation was based on census area of residence, researchers noted.

Results of the study showed that there were 1870 deaths during the 12-year study period. The 5-year survival rate was 32%.

Patients living in more deprived areas had a 16% to 21% greater likelihood of dying from ALL than patients living in the least deprived areas. However, the hazard ratio for patients living in rural and urban areas were comparable.


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Additionally, researchers found that hospitals treating low volumes of adults with ALL were associated with poor survival. The adjusted mortality hazard ratio was 1.33 for low-volume hospitals, which were pre-defined as hospitals with 15 or fewer patients with ALL admitted over a 3-year period for which data was available.

If the associations between socioeconomic deprivation and survival and between volume and outcome for patients with ALL are confirmed, there are likely to be significant implications for the organization of services for these patients, researchers noted.

“These results, although concerning, are from a single study, and further work is needed to confirm our findings,” commented Dr Maheswaran in an interview with Hematology Times (February 4, 2018).—Zachary Bessette