OS Disparity in Black vs White Patients With CLL in Community Oncology


Ira Zackon, MD, discusses the results of a real-world study evaluating racial and socioeconomic disparities among patients with chronic lymphocytic leukemia.

Ira Zackon, MD, hematologist/oncologist with New York Oncology Hematology, and a senior medical director with Ontada, a data science company part of McKesson, discusses the results of a real-world study evaluating racial and socioeconomic disparities among patients with chronic lymphocytic leukemia (CLL).


0:09 | What we saw in that population was first that when we looked at race, just the demographics, 91% of the patients were White, 5% were Black, and 4% were other. That is reasonably aligned with what we might expect in the general population for CLL as a disease. However, we could see some clear differences. One is that Black patients with CLL were a mean 2 years younger at diagnosis, so 68 years old vs 70 years old. Importantly, they also presented more at advanced stage CLL, stage III and IV, 55% of Black patients vs 45% of White. Stage III and IV is usually more symptomatic and needs treatment. Some patients may be diagnosed at earlier stages where there are not many symptoms. One can observe it for even many years before it needs treatment.

1:08 | Then looking at these social determinants of health factors, what we looked at was 2 because we used structured data. When taking care of patients, one is entering things, some of it is structured text that we can extract easily for purposes of data and analysis and research. We looked at total household income, as well as level of education. We saw differences in both of those measures where black patients with CLL overall had a lower level of education, in terms of high school or college or beyond, and then a lower level of income, where there were more patients with less than $30,000 to have total household income vs more than $30,000. So we stratified it.

2:00 | From there, recognizing some of these differences, we looked at the overall survival during this time period of data. In 8 years of data, we saw that the rate of death or like a mortality event was 61% in Black patients compared with only 43% in the White. That is almost a 20% difference in the overall survival. That is a real signal that there is something to pay attention to and recognize.

2:32 | When you go back and adjust statistically for these different factors, race alone did not maintain statistical significance, although we can recognize it is clinically and socially significant. But the household income being less than $30,000 retained its significance as a potential driver, or at least a significant contributor to that outcome of overall survival. Even though we only were able to collect that data in structured text for 25% overall of the population. We know there are unaccounted for and missing data, yet it still was recognized as an important driver.

3:16 | We concluded from this that we are seeing a difference in overall survival and between Black and White patients with CLL in the community oncology setting, and that financial limitations [are] potentially 1 of the factors contributing towards that. There is a lot more to understand in order to make solutions and make impacts. The goal is to see that gap disappear when we look again, in the future, hopefully understanding more about what is happening.

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