Sex Variability in Pediatric Leukemia Survival: Large Cohort Evidence

Purpose. Sex disparities in pediatric leukemia have been previously reported, and male children continue to present with poorer survival. However, the observed disparities are not fully understood. This current study sought to examine disparities in survival by the sex, and to determine if tumor prognostic factors impact on these disparities. Patients and Methods. We used the Surveillance Epidemiology and End Results dataset of pediatric leukemia patients (ages 0–19 years) diagnosed in the United States from 1973 to 2006. There were 15,215 patients of whom 8,622 (65.7%) were boys and 6,593 (43.3%) were girls. The Kaplan-Meier survival estimates, log rank test, and Cox proportional hazard methods were used to assess the data. Results. The overall (both sexes) five-year survival rate was 67.9%. Girls had a survival rate of 70.1%, while the rate was 66.3% in boys. Girls had a significant 14% decreased risk of dying relative to boys, hazard ratio (HR) = 0.86, 99% CI = 0.80–0.93. There were significant differences between boys and girls with respect to tumor cell type, race, age at diagnosis, year of diagnosis, and number of primaries, P < 0.001. After controlling for these factors, the sex differences in survival persisted, with girls still less likely to die from leukemia compared to boys, adjusted HR (AHR) = 0.85, 99% CI = 0.72–1.00, P < 0.01. Conclusion. In a large population-based pediatric leukemia study, boys continued to show poorer survival. These disparities were not completely explained by treatment received, tumor prognostic or socio-demographic factors

Reconsidering health disparities.

The 1990s were a prosperous decade in the United States. The Economic Report of the President noted that during the 1990s, the economic performance of the United States was both outstanding and sustainable. Between 1980 and 1996, median family income rose with each higher level of education for men and women in each racial/ethnic group. The year 1998 was an exceptional economic benchmark, with "the best performance in a generation." Dramatically, however, the terrorist acts of September 11, 2001, changed the economic underpinnings of our society and threatened the potential health status of the nation. As resources shift to support defense and economic slowdown is forecasted, decisions regarding allocation of both public and private resources for health and welfare are likely to be reexamined. Recent Department of Health and Human Services (DHHS) allocations of $2.9 billion in fiscal year 2002 for bioterrorism preparedness demonstrate that the national government will develop measures to preserve and protect the economic viability and health of the population