Impact of Socioeconomic Status on Acute Myeloid Leukaemia Outcomes in New Zealand’s Universal Healthcare

1. Socioeconomic deprivation is associated with poorer overall survival from AML, including APL, under New Zealand’s universal healthcare.

2. Socioeconomic deprivation adversely affects survival outcomes independently of ethnicity (European, Māori, or Pacific Peoples).

Socioeconomic deprivation and ethnic disparities are known to impact acute myeloid leukaemia (AML) outcomes. Understanding these effects is essential for informing policy and guiding clinical interventions to mitigate inequities. The purpose of this study was to define the roles of socioeconomic deprivation and ethnicity on the incidence and outcomes of adult AML, including acute promyelocytic leukaemia (APL), within New Zealand’s universal healthcare system. We analysed age-standardised incidence rates and overall survival relative to the patient’s age, ethnicity and socioeconomic status (New Zealand Deprivation Index) at diagnosis, using data extracted from the New Zealand Cancer Registry for all patients with AML diagnosed between 2000 and 2019. The study population comprised 3500 patients: 2678 European and 613 Polynesian (397 Māori, 216 Pacific Peoples). Results showed that socioeconomically deprived AML patients had a higher incidence and worse survival, and this impacted both European and Polynesian patients. In multivariate analysis, independent risk factors for survival included older age at diagnosis (P<0.001), socioeconomic deprivation (P=0.001), and non-APL disease (P<0.001), while ethnicity was not a significant risk (P=0.063). The effect of deprivation persisted in the context of APL treatment. Māori and Pacific patients diagnosed in their thirties or forties had poorer survival than their European counterparts, suggesting that ethnicity-associated factors diminished the survival advantage of younger age. In conclusion, our unique findings underscore the significant effect of socioeconomic deprivation on the outcomes of adult AML, highlighting an urgent need to elucidate underlying causes so that patient outcomes can improve across all societal groups.