Inequitable uptake of novel therapies (NT) in non-cancer settings are known for patients with lower socioeconomic status (SES), People of Color (POC), and older adults. NT uptake equity in acute myeloid leukemia (AML) is not well known. We performed a retrospective cohort study (1/2014-8/2022) of the United States nationwide Flatiron HealthTM electronic health record-derived, de-identified database. We estimated sociodemographic associations with AML NT receipt using incidence rate ratios (IRR). Odds ratios (OR) assessed differences in venetoclax (the most common NT) receipt at community sites and between site characteristics and NT adoption. Of 8081 patients (139 sites), 3102 (38%) received a NT. NT use increased annually (IRR 1.14, 95% confidence interval [1.07, 1.22]). NT receipt was similar between Non-Hispanic-Whites and POC (IRR 1.03, [0.91, 1.17]) and as age increased (IRR 1.02 [0.97, 1.07]). At community sites, Non-Hispanic-Whites were less likely to receive venetoclax (OR 0.77 [0.66, 0.91]); older age (OR 1.05 [1.04, 1.05]) and higher area-level SES were associated with venetoclax receipt (OR 1.23 [1.05, 1.43]). Early NT adopting sites had more prescribing physicians (OR 1.25 [1.13, 1.43]) and higher SES strata patients (OR 2.81 [1.08, 7.66]). Inequities in AML NT uptake were seen by SES; for venetoclax, differential uptake reflects its label indication for older adults and those with comorbidities.
已知社会经济地位较低的患者、有色人种及老年患者在非癌症领域对新型疗法的接受存在不公平现象。关于急性髓系白血病患者接受新型疗法的公平性情况尚不明确。我们基于美国全国性Flatiron Health™电子健康记录的脱敏数据库，开展了一项回顾性队列研究（时间范围：2014年1月至2022年8月）。通过发病率比评估了社会人口学特征与接受AML新型疗法的关联性，并使用比值比评估了社区医疗机构间维奈托克（最常见的新型疗法）使用差异，以及医疗机构特征与新型疗法采用情况的关系。在8081名患者（涉及139家医疗机构）中，3102人（38%）接受了新型疗法。新型疗法的使用量逐年增加（IRR 1.14，95%置信区间[1.07, 1.22]）。非西班牙裔白人与有色人种在新型疗法接受率上相近（IRR 1.03 [0.91, 1.17]），且该比例不随年龄增长而变化（IRR 1.02 [0.97, 1.07]）。在社区医疗机构中，非西班牙裔白人接受维奈托克治疗的可能性较低（OR 0.77 [0.66, 0.91]）；而年龄增长（OR 1.05 [1.04, 1.05]）和地区社会经济水平较高（OR 1.23 [1.05, 1.43]）与维奈托克使用呈正相关。早期采用新型疗法的医疗机构拥有更多执业医师（OR 1.25 [1.13, 1.43]）及更高社会经济层次的患者群体（OR 2.81 [1.08, 7.66]）。研究显示，AML新型疗法的接受度在社会经济层面存在不公平性；就维奈托克而言，其使用差异反映了该药物针对老年患者及合并症患者的标签适应症特点。
Sociodemographic associations with uptake of novel therapies for acute myeloid leukemia
肿瘤(癌症)患者之家