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A Cross-Sectional Study Examining the Prevalence of Acute Promyelocytic Leukemia in the United States: A SEER Study
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Received: ,
Accepted: ,
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Acute promyelocytic leukemia (APL) is a common type of leukemia that causes an abnormal increase in promyelocytes, an immature white blood cell.1 We aimed to estimate the prevalence of primary APL 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.
This study was deemed Institutional Review Board exempt. We performed a cross-sectional analysis of the SEER database by identifying patients with a diagnosis of APL using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 205.0 and ICD-10-CM code C92.40. Electronic medical records of each patient with APL were then analyzed to collect data on age, sex, and self-identified race. We utilized SEER's estimates with 95% confidence intervals to calculate the overall prevalence of APL.
Currently, the SEER database has enrolled 43,926,824 patients (Table 1). We identified 1,558.2 with APL, representing an overall prevalence of 0.00354726%. The prevalence was highest in the 50 to 54 age group, increasing with age. Prevalence in specific racial groups included 0.003834716% in white, 0.002777179% in black, 0.00178368% in American Indian/Alaska Native, and 0.002778717% in Asian or Pacific Islander patients (Table 1). In addition, the SEER database can be used to depict the mortality rates in APL; in white populations the mortality rate was 9.7%, in black populations the mortality rate was 5.5%, in American Indian/Alaska Native populations the mortality rate was 6.25%, and in the Asian or Pacific Islander populations the mortality rate was 9.9%.
|
Group |
Estimated prevalence percent |
Estimated prevalence Count |
Population at prevalence date |
Known alive |
Lost |
Lost estimated alive |
Dead prior to prevalence date |
|---|---|---|---|---|---|---|---|
|
White |
0.00 |
1,198 |
31,240,899 |
1,100 |
117 |
98 |
745 |
|
Black |
0.00 |
145.1 |
5,224,726 |
139 |
8 |
6.1 |
85 |
|
American Indian/Alaska Native |
0.00 |
16 |
897,021.5 |
15 |
1 |
1 |
7 |
|
Asian or Pacific Islander |
0.00 |
182.4 |
6,564,178.5 |
168 |
18 |
14.4 |
107 |
|
Unknown |
16.7 |
0 |
13 |
4 |
3.7 |
0 |
|
|
00 years at previous date |
0.00 |
0 |
522,150 |
0 |
0 |
0 |
0 |
|
01–04 years at previous date |
0.00 |
2 |
2,159,900.5 |
2 |
0 |
0 |
1 |
|
05–09 years at previous date |
0.00 |
3 |
2,732,193.5 |
3 |
0 |
0 |
0 |
|
10–14 years at previous date |
0.00 |
15.4 |
2,,786,556.5 |
14 |
2 |
1.4 |
4 |
|
15–19 years at previous date |
0.00 |
36.9 |
2,781,405 |
34 |
3 |
2.9 |
7 |
|
20–24 years at previous date |
0.00 |
71 |
2,954,646.5 |
70 |
1 |
1 |
11 |
|
25–29 years at previous date |
0.00 |
96.5 |
3,391,241 |
90 |
8 |
6.5 |
24 |
|
30–34 years at previous date |
0.00 |
109.8 |
3,191,280.5 |
100 |
11 |
9.8 |
27 |
|
35–39 years at previous date |
0.00 |
129.4 |
3,049,214.5 |
115 |
18 |
14.4 |
33 |
|
40–44 years at previous date |
0.00 |
160.2 |
2,779,268.5 |
142 |
21 |
18.2 |
39 |
|
45–49 years at previous date |
0.00 |
156.1 |
2,889,978.5 |
136 |
24 |
20.1 |
42 |
|
50–54 years at previous date |
0.00 |
161.1 |
2,837,532.5 |
147 |
17 |
14.1 |
64 |
|
55–59 years at previous date |
0.00 |
139.6 |
2,873,440 |
128 |
13 |
11.6 |
75 |
|
60–64 years at previous date |
0.01 |
148 |
2,591,284.5 |
133 |
18 |
15 |
98 |
|
65–69 years at previous date |
0.00 |
110 |
2,124,581 |
110 |
0 |
0 |
81 |
|
70–74 years at previous date |
0.01 |
90.2 |
1,598,623.5 |
86 |
5 |
4.2 |
68 |
|
75–79 years at previous date |
0.00 |
57.6 |
1,077,416 |
55 |
5 |
2.6 |
88 |
|
80–84 years at previous date |
0.00 |
43.4 |
736,037 |
43 |
1 |
0.4 |
69 |
|
85+ years at previous date |
0.00 |
28 |
850,075.5 |
27 |
1 |
1 |
213 |
Additionally, the SEER database consists of 71% white, 12% black, 2% American-Indian, and 15% Asian-Pacific Islanders,2 while the demographic makeup of the United States is 76% white, 14% black, 1% American-Indian, and 7% Asian.3 Consequently, our APL prevalence calculation may underestimate the white and black populations while overestimating the Hispanic and Asian populations. Furthermore, it is probable that there are more unaccounted-for patients due to their U.S. residency status, health care availability, and census limitations. Using a chi-squared test of independence, we found no significant difference between the SEER and U.S. Census populations (Table 1). Our analysis showed no significant relationship between the two populations, chi-square (3, N = 304,167,848) = 3404209.8855, p < 0.00001 (Table 2). Thus, our findings suggest that the SEER database and the U.S. Census population are statistically similar, allowing for an estimate of the U.S. population using SEER data.
|
Estimated SEER population in 2018 |
Estimated USA 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 (3737380.93) [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: The observed population was recorded in each cell, the expected population was indicated in parentheses, and the chi statistics are in brackets. The overall chi-square statistic was calculated as 3404209.8855. The p-value was found to be less than 0.00001, at a significance level of less than 0.05.
Altogether, our data suggest APL is a common leukemia across white, black, and Asian racial groups. Given the prevalence observed in black patients, we advocate for greater educational representation of APL in darker skin types. Further epidemiologic studies that are not restricted by billing codes may validate our findings.
References
- Acute promyelocytic leukemia: recent advances in diagnosis and management. Semin Oncol. 2008;35(04):401-409.
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