Association of the social disorganization index with time to first septic shock event in children with acute myeloid leukemia

Ruiz J, Li Y, Cao L, Huang YV, Tam V, Griffis HM, Winestone LE, Fisher BT, Alonzo TA, Wang YJ, Dang AT, Kolb EA, Glanz K, Getz KD, Aplenc R, Seif AE. Association of the social disorganization index with time to first septic shock event in children with acute myeloid leukemia. Cancer. 2024 Mar 15;130(6):962-972. doi: 10.1002/cncr.35109. Epub 2023 Nov 20. PubMed PMID: 37985388; PubMed Central PMCID: PMC10922804.

Pediatric acute myeloid leukemia (AML) chemotherapy increases the risk of life-threatening complications including septic shock (SS). We hypothesized an area-based measure of social determinants of health, the Social Disorganization Index (SDI), would be associated with SS and SS-associated death (SS-death). Children treated for de novo AML on two Children’s Oncology Group (COG) trials at institutions contributing to the Pediatric Health Information System (PHIS) database were included. SDI was calculated using residential ZIP code data from the US Census Bureau. SS was identified using PHIS resource utilization codes. SS-death was defined as death within 2 weeks of an antecedent SS event. Patients were followed from 7 days after start of chemotherapy until the first of: end of front-line therapy, death, relapse, or removal from study. Multivariable-adjusted Cox regressions estimated hazard ratios (HR) comparing time to first SS by SDI groups.