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Residence in a Hispanic Enclave Is Associated with Inferior Overall Survival among Children with Acute Lymphoblastic Leukemia

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  • Jeremy M. Schraw

    (Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
    Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA)

  • Erin C. Peckham-Gregory

    (Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
    Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA)

  • Amy E. Hughes

    (Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
    Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA)

  • Michael E. Scheurer

    (Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
    Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA)

  • Sandi L. Pruitt

    (Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
    Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA)

  • Philip J. Lupo

    (Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
    Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA)

Abstract

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 association 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 diagnosis, 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). Observations suggest that children with ALL residing in Hispanic enclaves experience inferior OS.

Suggested Citation

  • Jeremy M. Schraw & Erin C. Peckham-Gregory & Amy E. Hughes & Michael E. Scheurer & Sandi L. Pruitt & Philip J. Lupo, 2021. "Residence in a Hispanic Enclave Is Associated with Inferior Overall Survival among Children with Acute Lymphoblastic Leukemia," IJERPH, MDPI, vol. 18(17), pages 1-11, September.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:17:p:9273-:d:627882
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    References listed on IDEAS

    as
    1. Singh, G.K., 2003. "Area Deprivation and Widening Inequalities in US Mortality, 1969-1998," American Journal of Public Health, American Public Health Association, vol. 93(7), pages 1137-1143.
    2. Sandi L. Pruitt & Jasmin A. Tiro & Lei Xuan & Simon J. Craddock Lee, 2016. "Hispanic and Immigrant Paradoxes in U.S. Breast Cancer Mortality: Impact of Neighborhood Poverty and Hispanic Density," IJERPH, MDPI, vol. 13(12), pages 1-14, December.
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