Living along US-Mexico border linked to higher risk for death among children with leukemia
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Children with acute lymphoblastic leukemia who resided along the U.S.-Mexico border appeared at higher risk for death than their counterparts in other areas of Texas, according to study results published in Cancer.
However, among children with acute myeloid leukemia, researchers observed an increased risk for death only among those who resided in rural border counties.
Rationale and methodology
The border region has a combination of several risk factors for poor cancer outcomes, including high concentrations of poverty, long distances to health care and large Hispanic enclaves, Lena E. Winestone, MD, MSHP, assistant professor of pediatrics in the division of allergy, immunology, and blood and marrow transplant at University of California, San Francisco, Benioff Children’s Hospital, told Healio.
“Cancer survival was previously shown to be lower in adults who reside in the U.S.-Mexico border region relative to those outside of the border region. Previous studies have also shown substantially worse survival among the pediatric and adolescent Latinx population with ALL,” Winestone said.
These findings led to the question of whether border residence impacts outcomes in pediatric leukemia, she said.
“This is particularly important to address because previous studies evaluating rurality as a social determinant of pediatric cancer access and outcomes have been mixed,” Winestone said. “We know that place matters; understanding how communities where patients and their families live impact outcomes is essential for addressing survival disparities.”
The retrospective survival analysis included data on 6,002 children diagnosed with ALL and 1,279 diagnosed with AML between 1995 and 2017 and included in the Texas Cancer Registry.
Researchers used Cox proportional hazards models to evaluate factors associated with risk for death and Kaplan-Meier methods to calculate OS estimates.
Findings
Researchers reported a 5-year OS rate of 77.5% among children with ALL who resided in the border region compared with 85.8% among their counterparts in nonborder areas.
Results of adjusted models analyses that accounted for sex, race and ethnicity, age, socioeconomic status and rurality showed children with ALL who resided along the U.S.-Mexico border experienced a 30% increased hazard for death compared with those in nonborder areas.
“We also found that neighborhood poverty, health insurance, race and ethnicity still increase the hazard of death, suggesting that border residence by itself doesn’t fully explain these previously documented disparities,” Winestone said.
Researchers observed no significant variation in survival estimates according to border residency among children with AML.
“Interestingly, the relationship between border residence and outcome was less clear in children with AML, possibly due to the intensive inpatient approach to treatment,” Winestone said. “However, when we compared children living in nonmetropolitan areas, we observed a twofold increased risk for mortality among children with AML living in rural border regions compared with those living in rural nonborder regions.”
Implications
The findings highlight the importance of understanding the contextual factors in patients’ lives and being aware of where they reside, Winestone told Healio.
“Mobilizing additional resources and support for families who travel long distances for care is a first step to helping mitigate the financial burdens patients face,” she said. “The identification of at‐risk geographic regions also allows oncologists to advocate for additional investment of health care resources to serve these communities.”
Future studies should examine the impact of social determinants of health among this patient population, Winestone added.
“A natural next step for us is to evaluate the generalizability of these results, because while Texas accounts for more than half of the U.S.-Mexico border, the political environment in the state is unique and likely impacts health through insurance and social programs,” she said. “We are in the process of conducting a similar study evaluating leukemia survival among medically underserved communities, including border counties, in California.”
Cross‐border health care could be considered to improve clinical outcomes along both sides of the U.S.-Mexico border, according to an accompanying editorial by hematologist-oncologist Paula Aristizabal, MD, MAS, and Courtney D. Thornburg, MD, MS, medical director of the hemophilia and thrombosis treatment center — both at Rady Children’s Hospital-San Diego — and Janine Young, MD, associate professor at University of Colorado School of Medicine.
“Cross‐border health care involves an international agreement that allows citizens of partnered countries to receive health care out of country. Provision of cross‐border health care includes transferring of patients, mobilization of health care teams, and/or international telehealth visits,” the editorial authors wrote. “Eliminating cancer disparities in minoritized populations is imperative. Future studies should address social‐behavioral patterns and the impact of poverty, legal status, birth country, limited English proficiency and other potential barriers to high‐quality health care delivery in the U.S.-Mexico border region.”
References:
- Aristizabal P, et al. Cancer. 2023;doi:10.1002/cncr.34629.
- Castellanos MI, et al. Cancer. 2023;doi:10.1002/cncr.34636.
- Does living along the US-Mexico border affect the chances of survival among children with leukemia? (press release). Available at: newsroom.wiley.com/press-releases/press-release-details/2023/Does-living-along-the-US-Mexico-border-affect-the-chances-of-survival-among-children-with-leukemia/default.aspx. Published Feb. 21, 2023. Accessed Feb. 23, 2023.
For more information:
Lena E. Winestone, MD, MSHP, can be reached at lena.winestone@ucsf.edu.
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