TY - JOUR
T1 - Residence in a hispanic enclave is associated with inferior overall survival among children with acute lymphoblastic leukemia
AU - Schraw, Jeremy M.
AU - Peckham-Gregory, Erin C.
AU - Hughes, Amy E.
AU - Scheurer, Michael E.
AU - Pruitt, Sandi L.
AU - Lupo, Philip J.
N1 - Publisher Copyright:
© 2021 by the authors. Li-censee MDPI, Basel, Switzerland.
PY - 2021/9
Y1 - 2021/9
N2 - Hispanic children with acute lymphoblastic leukemia (ALL) experience poorer overall survival (OS) than non-Hispanic White children; however, few studies have investigated the social determinants of this disparity. In Texas, many Hispanic individuals reside in ethnic enclaves—areas with high concentrations of immigrants, ethnic-specific businesses, and language isolation, which are often socioeconomically deprived. We determined whether enclave residence was associated with ALL survival, overall and among Hispanic children. We computed Hispanic enclave index scores for Texas census tracts, and classified children (N = 4083) as residing in enclaves if their residential tracts scored in the highest statewide quintile. We used Cox regression to evaluate the asso-ciation between enclave residence and OS. Five-year OS was 78.6% for children in enclaves, and 77.8% for Hispanic children in enclaves, both significantly lower (p <0.05) than the 85.8% observed among children not in enclaves. Children in enclaves had increased risk of death (hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.01–1.49) after adjustment for sex, age at diagnosis, year of diag-nosis, metropolitan residence and neighborhood socioeconomic deprivation and after further adjustment for child race/ethnicity (HR 1.19, 95% CI 0.97–1.45). We observed increased risk of death when analyses were restricted to Hispanic children specifically (HR 1.30, 95% CI 1.03–1.65). Obser-vations suggest that children with ALL residing in Hispanic enclaves experience inferior OS.
AB - Hispanic children with acute lymphoblastic leukemia (ALL) experience poorer overall survival (OS) than non-Hispanic White children; however, few studies have investigated the social determinants of this disparity. In Texas, many Hispanic individuals reside in ethnic enclaves—areas with high concentrations of immigrants, ethnic-specific businesses, and language isolation, which are often socioeconomically deprived. We determined whether enclave residence was associated with ALL survival, overall and among Hispanic children. We computed Hispanic enclave index scores for Texas census tracts, and classified children (N = 4083) as residing in enclaves if their residential tracts scored in the highest statewide quintile. We used Cox regression to evaluate the asso-ciation between enclave residence and OS. Five-year OS was 78.6% for children in enclaves, and 77.8% for Hispanic children in enclaves, both significantly lower (p <0.05) than the 85.8% observed among children not in enclaves. Children in enclaves had increased risk of death (hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.01–1.49) after adjustment for sex, age at diagnosis, year of diag-nosis, metropolitan residence and neighborhood socioeconomic deprivation and after further adjustment for child race/ethnicity (HR 1.19, 95% CI 0.97–1.45). We observed increased risk of death when analyses were restricted to Hispanic children specifically (HR 1.30, 95% CI 1.03–1.65). Obser-vations suggest that children with ALL residing in Hispanic enclaves experience inferior OS.
KW - Acute lymphoblastic leukemia
KW - Childhood cancer
KW - Epidemiology
KW - Ethnic enclave
KW - Geographic information systems
KW - Health disparities
KW - Social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85114091981&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114091981&partnerID=8YFLogxK
U2 - 10.3390/ijerph18179273
DO - 10.3390/ijerph18179273
M3 - Article
C2 - 34501862
AN - SCOPUS:85114091981
SN - 1661-7827
VL - 18
JO - International journal of environmental research and public health
JF - International journal of environmental research and public health
IS - 17
M1 - 9273
ER -