Gengi Kleto
Acute myeloid leukemia (AML) is a common type of leukemia that affects myeloid stem
cells that are made into granulocytes, monocytes, and reticulocytes.[1] Treatment has rarely changed in the 20th to 21st century, and many minority communities
are undertreated.[1]
[2] We aimed to estimate the prevalence of AML using the Surveillance, Epidemiology,
and End Results (SEER) database, a recently launched initiative by the Surveillance Research Program in
National Cancer Institute's Division of Cancer and Population Sciences,[3] to effect better patient care that is tailored to sociodemographic factors. This
study was deemed Institutional Review Board exempt due to its retrospective nature.
We performed a cross-sectional analysis of the SEER database by identifying patients
with a diagnosis of AML using International Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) code 205.0 and ICD-10-CM code C92.00. Electronic
medical records of each patient with AML were then analyzed to collect data on age,
sex, and self-identified race. SEER provided the overall prevalence of AML based on
census data and estimations on populations lost to follow-up. As of 2020, the SEER
database has enrolled 43,926,825.00 cases, shown in [Table 1]. We used the latest available data, which encompasses 2017 to 2018 census data,
and identified 9,572.8 with AML, representing an overall prevalence of 0.04%. The
prevalence was highest in the 70 to 74 age group, increasing with age. Prevalence
in specific racial groups included 0.01% in white, 0.01% in black, 0.01% in American
Indian/Alaska Native, and 0.01% in Asian or Pacific Islander patients. Furthermore,
the SEER database is 71% white, 12% black, American-Indian 2%, and 15% Asian-Pacific
Islanders,[4] while the United States population is 76% white, 14% black, 1% American-Indian,
and 7% Asian.[5] Thus, our prevalence calculation of AML is an underestimation of the white and black
population, and an overestimation of the Hispanic and Asian population. It is also
likely that there are more patients that are unaccounted for due to U.S. residency
status, health care availability, and limitations of the census. Chi-squared test
of independence show that there is no significant difference between the SEER and
the U.S. Census population. There was not a significant relationship between the two
populations, chi-square (3, N = 304,167,848) = 3,404,209.8855, p < 0.00001 ([Table 2]). This result suggests that these populations are statistically similar and allow
an estimation of the U.S. population using SEER. Altogether, our data suggest AML
is a common leukemia across all racial groups. Further epidemiologic studies that
are not restricted by billing codes may validate our findings. Understanding sociodemographic
factors can increase clinical practice diversity and inclusivity to increase diagnosis
and treatment among minority populations.
Table 1
Demographic distribution of prevalence percentage and numbers of acute myeloid leukemia,
including race and age
|
Group
|
Estimated prevalence percent
|
Estimated prevalence count
|
Population at prevalence date
|
Known alive
|
Lost
|
Lost estimated alive
|
Dead prior to prevalence date
|
|
White
|
0.01%
|
3,222.8
|
31,240,899
|
4,792
|
563
|
348.8
|
19,163
|
|
Black
|
0.01%
|
543.6
|
5,224,726
|
536
|
46
|
32.6
|
1,871
|
|
American Indian/Alaska Native
|
0.01%
|
74
|
897,021.5
|
79
|
2
|
1
|
150
|
|
Asian or Pacific Islander
|
0.01%
|
842.9
|
6,564,178.5
|
799
|
124
|
75.9
|
2,509
|
|
Unknown
|
|
54.6
|
0
|
40
|
22
|
14.6
|
44
|
|
00 years at previous date
|
0.00%
|
3
|
522,150
|
3
|
0
|
0
|
1
|
|
01–04 years at previous date
|
0.00%
|
79.2
|
2,159,900.5
|
86
|
5
|
2.2
|
23
|
|
05–09 years at previous date
|
0.00%
|
134.3
|
2,732,193.5
|
116
|
21
|
18.3
|
51
|
|
10–14 years at previous date
|
0.01%
|
191
|
2,786,556.5
|
160
|
35
|
31
|
74
|
|
15–19 years at previous date
|
0.01%
|
222.9
|
2,781,405
|
204
|
28
|
24.9
|
127
|
|
20–24 years at previous date
|
0.01%
|
322.5
|
2,954,646.5
|
301
|
24
|
21.5
|
189
|
|
25–29 years at previous date
|
0.01%
|
353.3
|
3,391,241
|
328
|
31
|
25.3
|
255
|
|
30–34 years at previous date
|
0.01%
|
355.6
|
3,191,280.5
|
321
|
42
|
34.6
|
286
|
|
35–39 years at previous date
|
0.01%
|
414.5
|
3,049,214.5
|
368
|
55
|
46.5
|
354
|
|
40–44 years at previous date
|
0.01%
|
460.8
|
2,779,268.5
|
398
|
75
|
62.8
|
393
|
|
45–49 years at previous date
|
0.01%
|
546.7
|
2,889,978.5
|
482
|
78
|
64.7
|
517
|
|
50–54 years at previous date
|
0.02%
|
601.9
|
2,837,532.5
|
551
|
65
|
50.9
|
607
|
|
55–59 years at previous date
|
0.02%
|
615.2
|
2,873,440
|
555
|
71
|
60.2
|
891
|
|
60–64 years at previous date
|
0.02%
|
142
|
2,591,284.5
|
642
|
64
|
10
|
1,239
|
|
65–69 years at previous date
|
0.02%
|
113.9
|
2,124,581
|
613
|
33
|
5.9
|
1,574
|
|
70–74 years at previous date
|
0.03%
|
107.5
|
1,598,623.5
|
516
|
33
|
6.5
|
1,954
|
|
75–79 years at previous date
|
0.02%
|
70.6
|
1,077,416
|
300
|
33
|
6.6
|
2,173
|
|
80–84 years at previous date
|
0.00%
|
0
|
736,037
|
194
|
20
|
0
|
2,467
|
|
85+ years at previous date
|
0.00%
|
3
|
850,075.5
|
108
|
44
|
1
|
10,562
|
Table 2
Chi-square test of independence for SEER and U.S. race proportions estimated in 2018
|
Estimated SEER population in 2018
|
Estimated U.S. population in 2018
|
Row totals
|
|
White
|
31,240,899 (33,049,304.38) [98,953.07]
|
197,606,407 (195,798,001.62) [16,702.57]
|
228,847,306
|
|
Black
|
5,224,726 (6,661,487.98) [309,883.47]
|
40,902,223 (39,465,461.02) [52,306.12]
|
46,126,949
|
|
American-Indian
|
897,022 (478,652.71) [365,678.20]
|
2,417,371 (2,835,740.29) [61,723.87]
|
3,314,393
|
|
Asian-Pacific Islander
|
6,564,179 (3,737,380.93) [2,138,071.41]
|
19,315,021 (22,141,819.07) [360,891.18]
|
25,879,200
|
|
Column totals
|
43,926,826
|
2.6E + 8
|
304,167,848 (grand total)
|
Abbreviation: SEER, Surveillance, Epidemiology, and End Results.
Note: Observed population in each cell, expected in parentheses, and chi-square statistics
in brackets. Chi-square statistic is 3,404,209.8855. The p-value is < 0.00001. The result is significant at p < 0.05.
