Impact of socioeconomic status on acute myeloid leukemia outcomes in New Zealand’s universal health care

• Socioeconomic deprivation is associated with poorer overall survival from AML, including APL, under New Zealand’s universal health care. • Socioeconomic deprivation adversely affects survival outcomes independently of ethnicity (European, Māori, or Pacific Peoples). Socioeconomic deprivation and ethnic disparities are known to impact acute myeloid leukemia (AML) outcomes. Understanding these effects is essential for informing policy and guiding clinical interventions to mitigate inequities. The purpose of this study was to define the roles of socioeconomic deprivation and ethnicity on the incidence and outcomes of adult AML, including acute promyelocytic leukemia (APL), within New Zealand’s universal health care system. We analyzed age-standardized incidence rates and overall survival relative to the patient’s age, ethnicity, and socioeconomic status (New Zealand Deprivation Index) at diagnosis, using data extracted from the New Zealand Cancer Registry for all patients with AML diagnosed between 2000 and 2019. The study population comprised 3500 patients: 2678 European and 613 Polynesian (397 Māori, 216 Pacific Peoples). Results showed that socioeconomically deprived patients with AML had a higher incidence and worse survival, and this affected both European and Polynesian patients. In multivariate analysis, independent risk factors for survival included older age at diagnosis ( P < .001), socioeconomic deprivation ( P = .001), and non-APL disease ( P < .001), whereas ethnicity was not a significant risk ( P = .063). The effect of deprivation persisted in the context of APL treatment. Māori and Pacific Peoples patients diagnosed in their thirties or forties had poorer survival than their European counterparts, suggesting that ethnicity-associated factors diminished the survival advantage of younger age. In conclusion, our unique findings underscore the significant effect of socioeconomic deprivation on the outcomes of adult AML, highlighting an urgent need to elucidate underlying causes so that patient outcomes can improve across all societal groups.