The incidence and survival of acute de novo leukaemias in Estonia and in a well‐defined region of western Sweden during 1982–1996: a survey of patients aged ≥65 years

Abstract

. Objectives. To compare the incidence and survival of acute de novo leukaemias with particular reference to political/socio‐economic and environmental factors in two neighbouring countries over the three 5‐year periods (1982–1996). Patients. The present report covers only patients diagnosed when aged ≥65 years. Setting. A well‐defined area of Sweden, the so‐called Western Swedish Health Care Region and Estonia. Population‐wise, the western Swedish Region and Estonia are very similar; area‐wise they are also well comparable. Results. The number of acute de novo leukaemias was quite dissimilar in the two countries (Estonia, n = 137, Sweden, n = 354). The age standardized incidence rates regarding the total number of acute de novo leukaemias was 5.31 per 100 000 inhabitants/year for Estonia and 7.99 for Sweden, this difference being statistically significant. However, the difference was merely attributable to incidence rates as regards acute myeloblastic leukaemias (AML); on the contrary, differences as regards acute lymphoblastic leukaemias (ALL) and non‐classifiable, undifferentiated or biphenotypic acute leukaemias (uAL) were negligible. The relative survival for the total material of patients was significantly higher for Swedish when compared with Estonian patients (P < 0.001). Thus, the relative survival for the total material of patients aged ≥65 years in Estonia at 1 year was 8.5% and at 3 years 3.5% respectively. The corresponding figures for the Swedish patients were considerably higher, 22.7 and 7.7% respectively. This difference, however, applied only for patients with AML (P < 0.001), whereas the results for patients with ALL and uAL were equally dismal. Conclusion. The results clearly reflect how political and socio‐economic factors may influence the survival of acute leukemia patients in two neighbouring countries.

The Incidence and Survival of Acute de novo Leukemias in Estonia and in a Well-Defined Region of Western Sweden during 1997–2001: A Survey of Patients Aged 16–64 Years

“…over the 4 consecutive 5-year periods studied by us. Indeed, we recorded a similar increase in the incidence of de novo AML in the two cohorts of elderly patients (aged ≥65 years) [2,3]. Likewise, equivalent observations have been made by some other workers in their studies on AML epidemiology [15,16].…”

“…Even more conspicuous was the difference in crude as well as age-adjusted incidence rates between de novo AL patients in western Sweden and Estonia regarding elderly patients (aged ≥65 years at diagnosis) studied by us over the years 1982–1997 [2] and 1997–2001 [3]. In this respect it was also clearly demonstrated that in both the western Swedish and Estonian age cohorts the difference in incidence rates for the total group of de novo AL patients as well as for the subgroups of AML and ALL patients persisted over time.…”

“…However, since it is firmly established that both the incidence and outcome of treatment and therefore survival of AL is highly dependent upon the age of the patient, we decided to divide the study patients into two groups. The older patients were therefore reported on separately [2], as in the survey comprising the years 1997–2001 [3]. …”

Association of Human Development Index with rates and outcomes of hematopoietic stem cell transplantation for patients with acute leukemia

“…[20][21][22][23][24][25][26][27] With regard to adults with acute leukemia, the impact of the SES on survival was indirectly demonstrated by studies comparing patients treated between 1982 and 1996 in Estonia and Western Sweden, the 2 regions characterized by different political and economic systems, with similar ethnic and geographic background. 28,29 Swedish patients had a significantly higher chance of cure compared with their Estonian counterparts. 28,29 Fagundes et al, using the HDI to evaluate the SES of adults with AML in Brazil, showed the differences of outcome, which were in major part dependent on the compliance to chemotherapy protocol.…”

“…28,29 Swedish patients had a significantly higher chance of cure compared with their Estonian counterparts. 28,29 Fagundes et al, using the HDI to evaluate the SES of adults with AML in Brazil, showed the differences of outcome, which were in major part dependent on the compliance to chemotherapy protocol. 30 Until now, few studies focused on the association of socioeconomic factors with HSCT.…”