Disparities in childhood leukemia survival for Asian, Native Hawaiian, and Pacific Islanders in the United States

While some previous studies disaggregated the Asian, Native Hawaiian, and Pacific Islander (ANHPI) population to investigate survival for childhood leukemia, further studies are needed to understand the differences between subpopulations. The aim of our study was to estimate 5-year relative survival for patients with childhood leukemia and to investigate disparities in prognostic factors with disaggregation of the ANHPI population. We used the Surveillance, Epidemiology, and End Results Program 17 database and included 1881 ANHPI patients with childhood leukemia and 8772 non-Hispanic White (NHW) patients with childhood leukemia. The Cox proportional hazards model was used to estimate hazard ratios for the risk of death. We observed lower 5-year relative survival rates for Southeast Asian and East Asian compared to NHW patients with childhood leukemia for acute lymphoid leukemia (ALL). The survival rates were higher for patients diagnosed at 1-9 years of age, more recent years of diagnosis, and patients residing in urban areas. The risk of death was 42% higher for East Asian patients and 50% higher for Southeast Asian patients compared to NHW patients for childhood ALL. For prognostic factors among East Asian patients with childhood leukemia, higher risks of death were observed for patients diagnosed at <12 months old and for acute myeloid leukemia compared to ALL. Further studies are needed to elucidate the reasons behind the disparities in survival rates for Southeast Asian and East Asian patients with childhood leukemia, including socioeconomic and genetic contributions to leukemia risk and clinical responses to different therapeutic modalities.