Socio-economic status and survival in children with acute lymphoblastic leukemia

Background: The underlying mechanism of hyperglycemia in children with acute lymphoblastic leukemia (ALL) is insulin resistance. Although race and economic status have been linked to increased insulin resistance in children, these have not been explored as predictors of hyperglycemia in children with ALL. The objective of this study was to analyze race and income as predictors of hyperglycemia in a diverse sample of children hospitalized with ALL in the United States in the year 2016. Methods: We performed a secondary analysis of 18,077 hospitalizations of White, Black, and Hispanic children under the age of 21 years with ALL contained in a nationally representative database. Multilevel binary logistic regression models were constructed to estimate the relationships between race, median household income, age, sex, and obesity and the odds of hyperglycemia in hospitalized children with ALL. Results: Hyperglycemia occurred during 5.3% of the hospitalizations. Black children were 37% more likely to develop hyperglycemia than White children. The risk for hyperglycemia did not differ between Hispanic and White children. Residing in areas where annual median income was below $54,000 was associated with 1.4-fold increased odds of hyperglycemia, compared to the wealthiest areas. Older children, females, and those diagnosed with obesity were also at increased risk for hyperglycemia. Discussion: An association has been found between treatment-induced hyperglycemia and increased mortality. For this reason, the racial and economic differences in the risk for hyperglycemia identified in this study deserve further consideration.

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Association Of Health Care Expenditure With Results Of Allogeneic HSCT For Adults With ALL: An Analysis From Acute Leukemia Working Party Of The EBMT

Blood ◽

10.1182/blood.v122.21.2150.2150 ◽

2013 ◽

Vol 122 (21) ◽

pp. 2150-2150

Author(s):

Sebastian Giebel ◽

Myriam Labopin ◽

Adalberto Ibatici ◽

Paul Browne ◽

Tomasz Czerw ◽

...

Keyword(s):

Health Care ◽

Stem Cells ◽

Overall Survival ◽

Economic Status ◽

Lymphoblastic Leukemia ◽

Health Care Expenditure ◽

Univariate Analysis ◽

Hematopoietic Stem ◽

Socio Economic Status ◽

Center Activity

Abstract Background Results of allogeneic hematopoietic stem cell transplantation (aloHSCT) depend on many patient-, donor- and procedure-related factors. In recent years, in a setting of AML we demonstrated that also socio-economic status of a country and center experience may influence outcome. The goal of the current analysis, focused on patients with acute lymphoblastic leukemia (ALL), was to evaluate specific effects on non-relapse mortality (NRM) related to health care expenditure (HCE) of a country as well as distribution of transplant centers in addition to previously studied human development index (HDI) and center activity. Patients and methods Results of myeloablative alloHSCT from HLA-identical siblings performed between 2004-2008 for adults with ALL in CR1 were analyzed. Among 983 individuals treated in 27 European countries the median age was 35 (18-55) years and the interval from diagnosis to alloHSCT – 158 (42-831) days. TBI was used for conditioning in 820 (83%) cases and peripheral blood was a source of stem cells in 656 (67%) cases. The following factors were studied for their impact on outcome: current HCE, HCE as % of gross domestic product, public HCE, private HCE, no. of teams per country area and population, HDI and center activity (no. of alloHSCT for ALL in a study period). All variables were categorized by medians. The median follow-up was 34 months. Results In a univariate analysis the probability of day 100 NRM was increased for countries with lower current HCE (p=0.06), lower HDI (p=0.02) and for centers with lower experience (p=0.04). Also overall NRM was affected by current HCE (p=0.09), HDI (p=0.03) and center activity (p=0.07). In a multivariate model adjusted for recipient age, interval from diagnosis to HSCT, source of stem cells, type of conditioning, and donor/recipient gender, the variables of interest were included separately due to strong internal correlations. The best predictive model for day 100 NRM included HDI < median (HR = 2.38, 95%CI = 1.3-4.35, p=0.005). The overall NRM was most strongly predicted by current HCE < median (HR = 2.56, 95%CI = 1.41-4.76, p=0.002). In a univariate analysis lower values of HDI and current HCE were also associated with decreased probability of the overall survival (p=0.004 and p=0.006, respectively). Conclusion Both macroeconomic factors and the socio-economic status of a country influence strongly non-relapse mortality and overall survival after alloHSCT for adults with ALL. Our findings should be considered in interpretation of clinical studies in the field of alloHSCT. Disclosures: No relevant conflicts of interest to declare.

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Oral Language Behavior of Older Cerebral Palsied Children

Journal of Speech and Hearing Research ◽

10.1044/jshr.0704.349 ◽

1964 ◽

Vol 7 (4) ◽

pp. 349-359 ◽

Cited By ~ 3

Author(s):

Russell J. Love

Keyword(s):

Oral Language ◽

Economic Status ◽

Educational Background ◽

Socio Economic Status ◽

Language Behavior ◽

Hearing Acuity

A battery of six tests assessing various aspects of receptive and expressive oral language was administered to 27 cerebral palsied children and controls matched on the variables of age, intelligence, sex, race, hearing acuity, socio-economic status, and similarity of educational background. Results indicated only minimal differences between groups. Signs of deviancy in language behavior often attributed to the cerebral palsied were not observed. Although previous investigators have suggested consistent language disturbances in the cerebral palsied, evidence for a disorder of comprehension and formulation of oral symobls was not found.

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