Background:

Demographic factors such as race, sex, marital status, and rural-urban setting have been shown to be associated with differences in overall survival in patients with acute myeloid leukemia (AML). However, most of the studies published looked at patients diagnosed prior to 2015. This study looks at marital status, race, and rural-urban setting in patients diagnosed with AML between 2016-2021.

Methods:

Patients with AML diagnosed between 2016 and 2021 were identified in the Surveillance, Epidemiology, and End Results (SEER) database and stratified by race (Hispanic, non-Hispanic (NH) Asian and Pacific Islander (API), NH black and NH white), marital status (single, married, divorced, widowed), and rural-urban setting (based on the 2023 Rural-Urban Continuum Code Definitions). All AML subtypes were included in the study. Sub-groups with an n <200 were excluded. 5-year overall survival (5-OS) rates with 95% confidence intervals (CI) were calculated for each group. Kaplan-Meier survival analysis was used to compare survival outcomes across these variables. Multivariate analysis was performed with log-rank with stratification and cox proportional hazards model.

Results:

A total of 14,304 patients were identified in the SEER database. 5-OS differed significantly by race/ethnicity, with the highest rates observed in Hispanic (37.5%) and NH API (31.2%) patients, followed by Non Hispanic (NH) black (27.9%) and white (26.2%) patients. There was no significant difference in 5-OS between NH black and white individuals. Marital status was associated with statistically significant differences in 5-OS amongst patients who were single (40.8%), married (29.9%), divorced (24.3%), and widowed (5.8%) (p<0.01), in descending order of survival. By sex, females had higher 5-OS than males (32.6% vs 25.5%, p<0.01). No significant differences in 5-OS were found between counties in metropolitan areas (COMA) with>1 million people (30.1%) and COMA of 250,000-1 million people (28.5%). Thus, these two groups were combined as “urban”. Similarly, no significant difference in 5-OS was observed between COMA with <250,000 (25.8%), nonmetropolitan counties (NC) adjacent to metropolitan areas (MA) (23.9%) and NC not adjacent to MA (23.1%). These three groups were combined as “rural.” 5-OS was statistically higher for individuals living in urban settings compard to those living in rural settings (p<0.01).

Using multivariate analysis, after adjusting for marital status, 5-OS based on race showed a similar trend as above with 5-OS from highest to lowest: Hispanic, NH API, NH black and NH white for married (37.6%, 31.6%, 28.0%, 28.0% p<0.01) and single (49.2%, 43.0%, 38.3%, 37.6%, p<0.01) individuals. There was no significant difference in 5-OS for race for individuals who were divorced or widowed. Regarding marital status and gender, married females had higher 5-OS than married males (37.5% vs 25.1%, p<0.01) and single females had higher 5-OS than single males (48.1% vs 34.9%, p<0.01). After adjusting for age, divorced, single and widowed individuals had a higher hazard of death compared to married individuals (HR = 1.24, 1.27, 1.18, p<0.01, respectively).

Conclusions:

Race, sex, marital status and urban-rural setting significantly impact AML survival in patients diagnosed from 2016 to 2021. While this data initially show that single individuals have the highest 5-OS, after correcting for age, married individuals still have the survival advantage. Furthermore, marriage seems to benefit females more than males. It is also beneficial to live in a more urban setting. It is important to take these factors into account when thinking about how to best treat our patients and considering additional support services that might benefit individuals who are NH black and white, unmarried, especially unmarried men, and those living in rural settings.

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2025
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