Epidemiology of Acute Myeloid Leukemia (AML)

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.

Publikationsverlauf

Eingereicht: 10. Januar 2025

Angenommen: 17. Januar 2025

Artikel online veröffentlicht:
31. März 2025

• References

• 1 Pelcovits A, Niroula R. Acute myeloid leukemia: a review. R I Med J (2013) 2020; 103 (03) 38-40
• 2 Medinger M, Heim D, Halter JP, Lengerke C, Passweg JR. Diagnosis and therapy of acute myeloid leukemia [in German]. Ther Umsch 2019; 76 (09) 481-486
• 3 SEER Incidence Data. 1975–2019. Accessed January 28, 2023 at: https://seer.cancer.gov/data/
• 4 Cancer Statistics Review SEER. 1975–2018. Accessed March 2, 2023 at: https://seer.cancer.gov/csr/1975_2018/index.html
• 5 Bureau UC. 2018 Population Estimates by Age, Sex, Race and Hispanic Origin. Accessed March 30, 2023 at: https://www.census.gov/newsroom/press-kits/2019/detailed-estimates.html