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Survival after acute lymphocytic leukaemia: effects of socioeconomic status and geographic region

Abstract

National cancer registry data, linked to an areal measure of material deprivation, were used to explore possible socioeconomic and regional variation in the survival of children (0–14 years) diagnosed with acute lymphocytic leukaemia (ALL) in England and Wales from 1971 to 1990. Survival analysis and Poisson regression were used to estimate observed (crude) survival probabilities and the adjusted hazard of death. There was little evidence of a socioeconomic gradient in survival. Regional differences in survival were observed over time. These differences were most pronounced in the first six months after diagnosis, and may be attributable to differential access to centralised paediatric oncology services or treatment protocols, or to the artefact of variations in regional cancer registry practice. Similar analyses should be repeated for other, less treatable childhood cancers. The results of this study can be used to help identify ways of reducing regional variation in survival.

  • acute lymphocytic leukaemia
  • survival
  • socioeconomic status
  • regional variation
  • England and Wales

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Footnotes

  • *   The proportion of households headed by a person of social class IV or V is coded at the level of the census ward, and this value assigned to the approximately 10 EDs within each ward.

  •   The log transformed value of percentage unemployment is used. ‡  Although this analysis is limited to children diagnosed with ALL while living in England and Wales, the distribution of Carstairs scores from which deprivation categories were derived includes EDs for all of the UK (England, Wales, and Scotland) to provide a national standard distribution. §  Relative survival is the preferred measure of survival in studies among adult cancer patients, because adults can die from causes other than the cancer under study. For children, however, there are few competing causes of death so that crude survival rates are likely to be very close to net survival, and thus may be preferred to relative survival.

  •   In all instances in which data have been cited, but not shown, data are available from the author on request.

  • **   When we excluded patients diagnosed in 1971–75 for whom a deprivation category could not be calculated the one year survival estimate for the West Midlands region decreased (from 70% to 66%) and the five-year survival estimate increased only slightly (from 33% to 36%).

  • 164   A lack of significance may be considered less important in a population based study such as this one than in a study that derives a sample from some larger population. Although variations in the case ascertainment, follow up, and reporting practices of different cancer registries may have introduced some bias, the differences in survival observed in this population based data may be considered to reflect the actual survival experience of children diagnosed with ALL in England and Wales in 1971–90.

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