Cancer Causes & Control

, Volume 23, Issue 5, pp 737–743 | Cite as

Racial and ethnic disparities in survival of US children with acute lymphoblastic leukemia: evidence from the SEER database 1988–2008

  • William B. GogginsEmail author
  • Fiona F. K. Lo
Original paper



Prior studies have shown poorer survival from childhood acute lymphoblastic leukemia (ALL) among some minorities compared to non-Hispanic whites (NHW). Here, we examine whether these survival disparities have persisted and to see whether they also exist for Asian and Hispanic subgroups.


Using data from the US National Cancer Institute’s Surveillance, Epidemiology and End Results program from 1988 to 2008, we compared all natural-cause survival for children aged 19 years or under diagnosed with ALL using Cox proportional hazards models adjusted for age, diagnosis year, gender and disease immunophenotype.


Black, Hispanic and Native American children continue to have significantly poorer survival than NHW. Unlike previous studies, we found that Asian Americans also had significantly worse survival. Among Asian subgroups, Vietnamese (relative risk [RR] = 2.44, 95 % CI = 1.50–3.97) and Filipinos (RR = 1.64, 95 % CI = (1.13–2.38) had significantly poorer survival, while other East Asian groups, except Chinese, had non-significantly worse survival. Most Hispanic subgroups had RRs around 2.


Previously observed poorer prognosis for childhood ALL for some minority groups appears to be shared by most Asians as well. Further research is needed to find explanations for the poorer survival of minority children with ALL and possible treatment implications.


Childhood cancers Ethnic disparities Cancer survival Epidemiology 



This research was partially supported by Chinese University of Hong Kong Faculty of Medicine Direct Grant for Research Reference Number 2008.1.093. We wish to thank the editor and reviewer for their suggestions which have greatly improved the quality of the manuscript.

Conflict of Interest

The authors state that they have no conflicts of interest.


  1. 1.
    Howlader N, Noone AM, Krapcho M et al (eds) (2011) SEER cancer statistics review, 1975–2008, National Cancer Institute. Bethesda, MD,, based on November 2010 SEER data submission, posted to the SEER web site
  2. 2.
    Smith MA, Seibel NL, Altekruse SF et al (2010) Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J Clin Oncol 28:2625–2634PubMedCrossRefGoogle Scholar
  3. 3.
    Kadan-Lottick NS, Ness KK, Bhatia S et al (2003) Survival variability by race and ethnicity in childhood acute lymphoblastic leukemia. JAMA 290(15):2008–2014PubMedCrossRefGoogle Scholar
  4. 4.
    Bhatia S, Sather HN, Heerema NA et al (2002) Racial and ethnic differences in survival of children with acute lymphoblastic leukemia. Blood 100:1957–1964PubMedCrossRefGoogle Scholar
  5. 5.
    Pollock BH, DeBaun MR, Camitta BM et al (2003) Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia: a Pediatric Oncology Group study. J Clin Oncol 18:813–823Google Scholar
  6. 6.
    Chen X (2008) Score test of proportionality assumption for Cox models. Western Users of SAS Software 2008 Proceedings.
  7. 7.
    Therneau TM, Grambsch PM, Fleming TR (1990) Martingale-based residuals for survival models. Biometrika 77:147–169CrossRefGoogle Scholar
  8. 8.
    U.S. Census Bureau American Factfinder Fact Sheet for a Race, Ethnic or Ancestry group.
  9. 9.
    Goggins WB, Wong G (2009) Cancer among Asian Indians/Pakistanis living in the United States: low incidence and generally above average survival. Cancer Causes Control 20:635–643PubMedCrossRefGoogle Scholar
  10. 10.
    Goggins WB, Wong G (2007) Poor survival for US Pacific Islander cancer patients: evidence from the surveillance, epidemiology and end results database: 1991 to 2004. J Clin Oncol 36:5738–5741CrossRefGoogle Scholar
  11. 11.
    The American Community—Asians. American Community Survey Reports. February 2007. U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau.
  12. 12.
    Cohen IG (2012) Selling bone marrow—Flynn v. Holder. N Engl J Med 366:296–297PubMedCrossRefGoogle Scholar
  13. 13.
    Johnson KA, Aplenc R, Bagatell R (2011) Survival by race among children with extracranial solid tumors in the United States between 1985 and 2005. Pediatr Blood Cancer 56:425–431PubMedCrossRefGoogle Scholar
  14. 14.
    Lin SS, Clarke CA, Prehn AW et al (2002) Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast and cervical carcinomas. Cancer 94:1175–1182PubMedCrossRefGoogle Scholar
  15. 15.
    Ooi SL, Martinez ME, Li CI (2011) Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 127:729–738PubMedCrossRefGoogle Scholar
  16. 16.
    Clegg LX, Li FP, Hankey BF et al (2002) Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) program population-based study. Arch Intern Med 162:1985–1993PubMedCrossRefGoogle Scholar
  17. 17.
    Bhatia S (2004) Influence of race and socioeconomic status on outcome of children treated for childhood acute lymphoblastic leukemia. Curr Opin Pediatr 16:9–14PubMedCrossRefGoogle Scholar
  18. 18.
    Yang JJ, Cheng C, Devidas M et al (2011) Ancestry and pharmacogenetics of relapse in acute lymphoblastic leukemia. Nat Genet 43(3):237–241Google Scholar
  19. 19.
    Rubnitz JE, Pui CH (2003) Recent advances in the treatment and understanding of childhood acute lymphoblastic leukaemia. Cancer Treat Rev 29:31–44PubMedCrossRefGoogle Scholar
  20. 20.
    Collie-Duguid ES, Pritchard SC, Powrie RH et al (1999) The frequency and distribution of thiopurine methyltransferase alleles in Caucasian and Asian populations. Pharmacogenetics 9:37–42PubMedCrossRefGoogle Scholar
  21. 21.
    Lund MJ, Eliason MT, Haight AE et al (2009) Racial/ethnic diversity in children’s oncology clinical trials. Cancer 115:3808–3816PubMedCrossRefGoogle Scholar
  22. 22.
    Clegg LX, Reichman ME, Hankey BF et al (2007) Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies. Cancer Causes Control 18:177–187PubMedCrossRefGoogle Scholar
  23. 23.
    Conter V, Bartram CR, Valsecchi MG et al (2010) Molecular response to treatment redefines all prognostic factors in children and adolescents with B-cell precursor acute lymphoblastic leukemia: results in 3184 patients of the AIEOP-BFM ALL 2000 study. Blood 115:3206–3214PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Department of PsychologyChinese University of Hong KongShatinHong Kong

Personalised recommendations