Epidemiological characteristics and influencing factors of acute leukemia in children and adolescents and adults: a large population-based study

Figures & data

Figure 1. Flow chart of participant selection.

Table 1. Characteristics of the included AL patients.

Variables	Total (n = 61,694)	Adults (n = 45,411)	Children and adolescents (n = 16,283)	Statistics	P
Age, years, M (Q1, Q3)	52.00 (18.00, 69.00)	62.00 (47.00, 73.00)	5.00 (3.00, 12.00)	Z = −189.640	<0.001
Age, years, n (%)				χ^2= 61,694.00	<0.001
0–9	10,916 (17.69)	0 (0.00)	10,916 (67.04)
10–19	5367 (8.70)	0 (0.00)	5367 (32.96)
20–29	3637 (5.90)	3637 (8.01)	0 (0.00)
30–39	4038 (6.55)	4038 (8.89)	0 (0.00)
40–49	5312 (8.61)	5312 (11.70)	0 (0.00)
50–59	7559 (12.25)	7559 (16.65)	0 (0.00)
60–69	9552 (15.48)	9552 (21.03)	0 (0.00)
>69	15,313 (24.82)	15,313 (33.72)	0 (0.00)
Sex, n (%)				χ^2= 11.450	<0.001
Female	27,595 (44.73)	20,496 (45.13)	7099 (43.60)
Male	34,099 (55.27)	24,915 (54.87)	9184 (56.40)
Race, n (%)				χ^2= 96.190	<0.001
White	50,319 (81.56)	37,263 (82.06)	13,056 (80.18)
Black	5724 (9.28)	4195 (9.24)	1529 (9.39)
Other	5449 (8.83)	3856 (8.49)	1593 (9.78)
Unknown	202 (0.33)	97 (0.21)	105 (0.64)
Insurance, n (%)				χ^2= 2414.597	<0.001
Any Medicaid	5080 (8.23)	3007 (6.62)	2073 (12.73)
Insured	19,756 (32.02)	16,880 (37.17)	2876 (17.66)
Uninsured	701 (1.14)	593 (1.31)	108 (0.66)
Unknown	36,157 (58.61)	24,931 (54.90)	11,226 (68.94)
Histological type, n (%)				χ^2= 20,710.38	<0.001
ALL	20,990 (34.02)	7990 (17.59)	13,000 (79.84)
AML	39,150 (63.46)	36,077 (79.45)	3073 (18.87)
AUL	1554 (2.52)	1344 (2.96)	210 (1.29)
First primary malignancy, n (%)				χ^2= 3007.602	<0.001
No	8549 (13.86)	8367 (18.43)	182 (1.12)
Yes	53,145 (86.14)	37,044 (81.57)	16,101 (98.88)
Chemotherapy, n (%)				χ^2= 2632.928	<0.001
No/unknown	8811 (14.28)	8451 (18.61)	360 (2.21)
Yes	52,883 (85.72)	36,960 (81.39)	15,923 (97.79)
Radiation, n (%)				χ^2= 0.039	0.843
No	61,596 (99.84)	45,338 (99.84)	16,258 (99.85)
Yes	98 (0.16)	73 (0.16)	25 (0.15)
Surgery, n (%)				χ^2= 274.267	<0.001
No	482 (0.78)	359 (0.79)	123 (0.76)
Yes	47,911 (77.66)	36,007 (79.29)	11,904 (73.11)
Unknown	13,301 (21.56)	9045 (19.92)	4256 (26.14)
OS, n (%)				χ^2= 18,269.26	<0.001
Alive	18,808 (30.49)	7032 (15.49)	11,776 (72.32)
Dead	42,886 (69.51)	38,379 (84.51)	4507 (27.68)

Note: M (Q₁, Q₃): median and quartile; n (%): number of cases and constituent ratio; AL, acute leukemia; ALL, Acute lymphoblastic leukemia; AML, Acute myeloid leukemia; AUL, acute undifferentiated leukemia; OS, overall survival.

Figure 2. Incidence rate of AL, ALL, AML and AUL in children and adolescents and adults. (A) incidence in children and adolescents; (B) incidence in adults. AL, acute leukemia; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; AUL, acute undifferentiated leukemia; APC, annual percent changes.

Figure 3. OS of children and adolescents and adults with AL. OS, overall survival; AL, acute leukemia.

Figure 4. OS of children and adolescents. (A) OS of children and adolescents with ALL at different ages; (B) OS of children and adolescents with AML at different ages; (C) OS of children and adolescents with AUL at different ages. OS, overall survival; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; AUL, acute undifferentiated leukemia.

Figure 5. OS of adults. (A) OS of adults with ALL at different ages; (B) OS of adults with AML at different ages; (C) OS of adults with AUL at different ages. OS, overall survival; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; AUL, acute undifferentiated leukemia.

Table 2. Prognostic factors for OS in children and adolescents with ALL.

Variables	OS		1-year OS		5-year OS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
0–9	Ref		Ref		Ref
10–19	2.456 (2.281–2.645)	<0.001	2.708 (2.323–3.158)	<0.001	2.614 (2.406–2.839)	<0.001
Sex
Female	Ref		Ref		Ref
Male	1.210 (1.123–1.305)	<0.001	1.135 (0.971–1.327)	0.112	1.197 (1.100–1.303)	<0.001
Race
White	Ref		Ref		Ref
Black	1.416 (1.262–1.589)	<0.001	1.493 (1.192–1.870)	<0.001	1.440 (1.268–1.635)	<0.001
Other	1.085 (0.956–1.231)	0.206	1.100 (0.843–1.435)	0.483	1.090 (0.946–1.257)	0.233
Unknown	0.482 (0.241–0.967)	0.040	0.476 (0.118–1.919)	0.297	0.446 (0.200–0.994)	0.048
Insurance
Uninsured	Ref		Ref		Ref
Insured	0.493 (0.337–0.720)	<0.001	0.793 (0.369–1.707)	0.554	0.547 (0.363–0.822)	0.004
Any Medicaid	0.753 (0.515–1.101)	0.143	1.384 (0.645–2.967)	0.404	0.849 (0.564–1.276)	0.430
Unknown	0.550 (0.379–0.798)	0.002	0.667 (0.312–1.425)	0.296	0.582 (0.390–0.869)	0.008
First primary malignancy
No	Ref		Ref		Ref
Yes	0.488 (0.313–0.760)	0.001	0.273 (0.148–0.502)	<0.001	0.468 (0.293–0.747)	0.001
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	0.783 (0.607–1.011)	0.061	0.471 (0.311–0.713)	<0.001	0.785 (0.590–1.043)	0.096
Surgery
No	Ref		Ref		Ref
Yes	0.489 (0.358–0.669)	<0.001	0.341 (0.223–0.522)	<0.001	0.484 (0.353–0.663)	<0.001
Unknown	0.987 (0.713–1.366)	0.936	0.643 (0.404–1.025)	0.064	0.999 (0.719–1.389)	0.997

Note: ALL, acute lymphoblastic leukemia; OS, overall survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 3. Prognostic factors for OS in children and adolescents with AML.

Variables	OS		1-year OS		5-year OS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
0–9	Ref		Ref		Ref
10–19	1.167 (1.054–1.293)	0.003	0.999 (0.859–1.161)	0.988	1.175 (1.057–1.306)	0.003
Sex
Female	Ref		Ref		Ref
Male	1.050 (0.949–1.163)	0.345	1.007 (0.868–1.169)	0.925	1.043 (0.939–1.158)	0.435
Race
White	Ref		Ref		Ref
Black	1.283 (1.115–1.476)	<0.001	1.234 (1.009–1.510)	0.041	1.255 (1.086–1.451)	0.002
Other	1.181 (1.017–1.372)	0.030	0.943 (0.747–1.191)	0.624	1.177 (1.009–1.373)	0.038
Unknown	0.534 (0.239–1.196)	0.127	0.201 (0.028–1.435)	0.110	0.461 (0.191–1.113)	0.085
Insurance
Uninsured	Ref		Ref		Ref
Insured	1.011 (0.520–1.966)	0.974	1.146 (0.424–3.101)	0.788	1.009 (0.519–1.963)	0.978
Any Medicaid	1.214 (0.623–2.367)	0.569	1.333 (0.491–3.615)	0.573	1.200 (0.615–2.339)	0.593
Unknown	0.907 (0.469–1.755)	0.773	0.994 (0.369–2.674)	0.991	0.875 (0.452–1.693)	0.691
First primary malignancy
No	Ref		Ref		Ref
Yes	0.384 (0.313–0.470)	<0.001	0.287 (0.224–0.367)	<0.001	0.383 (0.311–0.471)	<0.001
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	0.805 (0.625–1.036)	0.092	0.684 (0.489–0.957)	0.027	0.774 (0.599–1.001)	0.051
Surgery
No	Ref		Ref		Ref
Yes	0.946 (0.392–2.284)	0.902	1.986 (0.278–14.167)	0.494	1.087 (0.406–2.910)	0.868
Unknown	1.734 (0.718–4.191)	0.221	3.495 (0.490–24.954)	0.212	2.035 (0.759–5.450)	0.158

Note: AML, acute myeloid leukemia; OS, overall survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 4. Prognostic factors for OS in children and adolescents with AUL.

Variables	OS		1-year OS		5-year OS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
0–9	Ref		Ref		Ref
10–19	1.660 (1.086–2.538)	0.019	1.317 (0.653–2.656)	0.442	1.578 (0.997–2.497)	0.051
Sex
Female
Male	1.108 (0.731–1.680)	0.628	0.608 (0.307–1.206)	0.155	1.063 (0.679–1.664)	0.789
Race
White	Ref		Ref		Ref
Black	1.158 (0.634–2.114)	0.633	1.396 (0.568–3.432)	0.467	1.135 (0.590–2.183)	0.705
Other	0.319 (0.078–1.307)	0.112	–	–	0.362 (0.088–1.488)	0.159
Unknown	4.767 (0.635–35.814)	0.129	7.887 (0.980–63.492)	0.052	5.027 (0.666–37.966)	0.118
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	0.771 (0.417–1.426)	0.406	0.565 (0.231–1.384)	0.212	0.738 (0.387–1.409)	0.357

Note: AUL, acute undifferentiated leukemia; OS, overall survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 5. Prognostic factors for OS in adults with ALL.

Variables	OS		1-year OS		5-year OS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
20–29	Ref		Ref		Ref
30–39	1.207 (1.103–1.321)	<0.001	1.327 (1.155–1.524)	<0.001	1.208 (1.100–1.326)	<0.001
40–49	1.522 (1.394–1.661)	<0.001	1.691 (1.482–1.930)	<0.001	1.497 (1.367–1.639)	<0.001
50–59	1.813 (1.665–1.974)	<0.001	1.902 (1.673–2.163)	<0.001	1.744 (1.597–1.905)	<0.001
60–69	2.212 (2.024–2.416)	<0.001	2.390 (2.099–2.721)	<0.001	2.099 (1.916–2.300)	<0.001
>69	3.421 (3.121–3.751)	<0.001	3.853 (3.386–4.385)	<0.001	3.266 (2.972–3.590)	<0.001
Sex
Female	Ref		Ref		Ref
Male	1.094 (1.041–1.150)	<0.001	1.045 (0.975–1.120)	0.212	1.091 (1.036–1.149)	<0.001
Race
White	Ref		Ref		Ref
Black	1.339 (1.232–1.455)	<0.001	1.374 (1.229–1.537)	<0.001	1.351 (1.240–1.472)	<0.001
Other	0.942 (0.861–1.031)	0.194	1.078 (0.955–1.218)	0.224	0.974 (0.887–1.068)	0.571
Unknown	0.563 (0.311–1.018)	0.057	0.774 (0.347–1.726)	0.531	0.646 (0.358–1.169)	0.149
Insurance
Uninsured	Ref		Ref		Ref
Insured	0.731 (0.617–0.866)	<0.001	0.752 (0.597–0.947)	0.016	0.742 (0.625–0.881)	<0.001
Any Medicaid	1.091 (0.913–1.304)	0.339	1.089 (0.854–1.389)	0.490	1.096 (0.915–1.314)	0.318
Unknown	0.732 (0.619–0.866)	<0.001	0.725 (0.576–0.913)	0.006	0.730 (0.616–0.866)	<0.001
First primary malignancy
No	Ref		Ref		Ref
Yes	0.851 (0.787–0.919)	<0.001	0.840 (0.760–0.929)	<0.001	0.837 (0.773–0.906)	<0.001
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	1.205 (1.100–1.319)	<0.001	0.906 (0.807–1.017)	0.096	1.272 (1.155–1.401)	<0.001
Surgery
No	Ref		Ref		Ref
Yes	0.817 (0.712–0.939)	0.004	0.771 (0.645–0.920)	0.004	0.812 (0.706–0.933)	0.003
Unknown	0.992 (0.850–1.157)	0.915	0.987 (0.807–1.209)	0.902	1.010 (0.863–1.181)	0.905

Note: ALL, acute lymphoblastic leukemia; OS, overall survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 6. Prognostic factors for OS in adults with AML.

Variables	OS		1-year OS		5-year OS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
20–29	Ref		Ref		Ref
30–39	1.070 (0.992–1.154)	0.078	1.059 (0.947–1.183)	0.317	1.045 (0.966–1.131)	0.271
40–49	1.330 (1.241–1.425)	<0.001	1.404 (1.270–1.552)	<0.001	1.275 (1.186–1.370)	<0.001
50–59	1.864 (1.748–1.989)	<0.001	1.915 (1.744–2.102)	<0.001	1.735 (1.623–1.855)	<0.001
60–69	2.579 (2.421–2.747)	<0.001	2.491 (2.275–2.727)	<0.001	2.377 (2.227–2.536)	<0.001
>69	3.912 (3.675–4.164)	<0.001	3.715 (3.398–4.062)	<0.001	3.614 (3.389–3.854)	<0.001
Sex
Female	Ref		Ref		Ref
Male	1.072 (1.048–1.096)	<0.001	1.031 (1.003–1.061)	0.031	1.062 (1.038–1.087)	<0.001
Race
White	Ref		Ref		Ref
Black	1.116 (1.074–1.160)	<0.001	1.091 (1.039–1.145)	<0.001	1.117 (1.073–1.162)	<0.001
Other	0.999 (0.958–1.041)	0.945	0.982 (0.932–1.035)	0.501	1.003 (0.961–1.046)	0.891
Unknown	0.570 (0.421–0.772)	<0.001	0.665 (0.456–0.971)	0.035	0.588 (0.431–0.802)	<0.001
Insurance
Uninsured	Ref		Ref		Ref
Insured	0.925 (0.825–1.038)	0.185	0.923 (0.796–1.071)	0.292	0.923 (0.822–1.036)	0.174
Any Medicaid	1.152 (1.020–1.301)	0.023	1.123 (0.960–1.314)	0.147	1.144 (1.011–1.293)	0.032
Unknown	0.834 (0.744–0.935)	0.002	0.854 (0.736–0.991)	0.038	0.826 (0.736–0.927)	0.001
First primary malignancy
No	Ref		Ref		Ref
Yes	0.843 (0.820–0.867)	<0.001	0.836 (0.809–0.864)	<0.001	0.841 (0.818–0.866)	<0.001
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	0.727 (0.707–0.749)	<0.001	0.652 (0.631–0.675)	<0.001	0.726 (0.705–0.748)	<0.001
Surgery
No	Ref		Ref		Ref
Yes	0.949 (0.759–1.186)	0.644	0.797 (0.616–1.032)	0.085	0.949 (0.755–1.193)	0.654
Unknown	1.228 (0.981–1.536)	0.072	0.987 (0.761–1.279)	0.919	1.228 (0.976–1.546)	0.080

Note: AML, acute myeloid leukemia; OS, overall survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 7. Prognostic factors for OS in adults with AUL.

Variables	OS		1-year OS		5-year OS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
20–29	Ref		Ref		Ref
30–39	1.425 (1.024–1.983)	0.036	1.520 (0.929–2.486)	0.096	1.315 (0.933–1.852)	0.118
40–49	1.508 (1.085–2.095)	0.015	1.822 (1.136–2.923)	0.013	1.424 (1.018–1.991)	0.039
50–59	2.226 (1.642–3.016)	<0.001	2.267 (1.459–3.522)	<0.001	1.882 (1.380–2.568)	<0.001
60–69	2.562 (1.918–3.423)	<0.001	2.516 (1.654–3.826)	<0.001	2.213 (1.650–2.968)	<0.001
>69	3.854 (2.898–5.125)	<0.001	3.951 (2.628–5.939)	<0.001	3.384 (2.540–4.507)	<0.001
Sex
Female	Ref		Ref		Ref
Male	0.968 (0.866–1.083)	0.575	0.960 (0.838–1.100)	0.557	0.974 (0.869–1.093)	0.656
Race
White	Ref		Ref		Ref
Black	1.142 (0.935–1.395)	0.193	1.203 (0.951–1.522)	0.123	1.165 (0.951–1.427)	0.140
Other	1.176 (0.928–1.490)	0.179	1.286 (0.980–1.688)	0.070	1.207 (0.951–1.532)	0.122
Unknown	0.310 (0.100–0.962)	0.043	–	0.950	0.336 (0.108–1.045)	0.060
Insurance
Uninsured	Ref		Ref		Ref
Insured	1.113 (0.565–2.193)	0.756	1.436 (0.583–3.534)	0.431	1.102 (0.560–2.172)	0.778
Any Medicaid	1.323 (0.627–2.791)	0.463	1.595 (0.607–4.194)	0.344	1.273 (0.603–2.687)	0.526
Unknown	1.019 (0.527–1.970)	0.956	1.222 (0.505–2.957)	0.656	0.994 (0.514–1.922)	0.985
First primary malignancy
No	Ref		Ref		Ref
Yes	0.891 (0.760–1.045)	0.156	0.857 (0.715–1.028)	0.097	0.885 (0.753–1.040)	0.139
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	0.916 (0.809–1.037)	0.166	0.804 (0.694–0.932)	0.004	0.919 (0.810–1.042)	0.187

Note: AUL, acute undifferentiated leukemia; OS, overall survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 8. Prognostic factors for CSS in children and adolescents with ALL.

Variables	CSS		1-year CSS		5-year CSS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
0–9	Ref		Ref		Ref
10–19	2.478 (2.286–2.686)	<0.001	2.283 (2.123–2.457)	<0.001	2.484 (2.293–2.691)	<0.001
Sex
Female	Ref		Ref		Ref
Male	1.186 (1.093–1.288)	<0.001	1.164 (1.079–1.255)	<0.001	1.186 (1.093–1.287)	<0.001
Race
White	Ref		Ref		Ref
Black	1.412 (1.242–1.605)	<0.001	1.362 (1.216–1.525)	<0.001	1.415 (1.246–1.607)	<0.001
Other	1.055 (0.918–1.213)	0.452	1.057 (0.930–1.203)	0.396	1.055 (0.918–1.212)	0.449
Unknown	0.612 (0.307–1.217)	0.161	0.617 (0.318–1.195)	0.152	0.601 (0.303–1.194)	0.146
Insurance
Uninsured	Ref		Ref		Ref
Insured	0.507 (0.347–0.742)	<0.001	0.555 (0.398–0.775)	<0.001	0.508 (0.345–0.747)	<0.001
Any Medicaid	0.699 (0.477–1.023)	0.066	0.758 (0.543–1.059)	0.105	0.705 (0.479–1.039)	0.077
Unknown	0.541 (0.373–0.785)	0.001	0.642 (0.464–0.888)	0.007	0.593 (0.407–0.864)	0.007
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	0.889 (0.659–1.201)	0.444	0.886 (0.673–1.166)	0.388	0.885 (0.657–1.192)	0.421
Surgery
No	Ref		Ref		Ref
Yes	0.518 (0.364–0.735)	<0.001	0.554 (0.407–0.753)	<0.001	0.527 (0.369–0.751)	<0.001
Unknown	1.059 (0.736–1.524)	0.757	1.096 (0.797–1.507)	0.572	1.116 (0.773–1.611)	0.560

Note: ALL, acute lymphoblastic leukemia; CSS, cancer-specific survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 9. Prognostic factors for CSS in children and adolescents with AML.

Variables	CSS		1-year CSS		5-year CSS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
0–9	Ref		Ref		Ref
10–19	1.170 (1.046–1.309)	0.006	1.146 (1.035–1.268)	0.009	1.172 (1.048–1.311)	0.005
Sex
Female	Ref		Ref		Ref
Male	1.043 (0.933–1.166)	0.461	1.042 (0.942–1.153)	0.420	1.044 (0.934–1.167)	0.449
Race
White	Ref		Ref		Ref
Black	1.210 (1.033–1.418)	0.018	1.178 (1.023–1.357)	0.023	1.212 (1.035–1.419)	0.017
Other	1.183 (1.007–1.390)	0.041	1.130 (0.979–1.303)	0.095	1.185 (1.009–1.392)	0.039
Unknown	0.663 (0.308–1.428)	0.294	0.670 (0.324–1.386)	0.281	0.657 (0.305–1.415)	0.283
Insurance
Uninsured	Ref		Ref		Ref
Insured	0.960 (0.443–2.080)	0.918	0.974 (0.481–1.974)	0.942	0.971 (0.446–2.115)	0.941
Any Medicaid	1.175 (0.541–2.551)	0.683	1.172 (0.578–2.377)	0.660	1.187 (0.544–2.590)	0.666
Unknown	0.872 (0.406–1.876)	0.727	0.919 (0.457–1.850)	0.813	0.900 (0.416–1.944)	0.788
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	1.048 (0.761–1.443)	0.775	1.000 (0.744–1.344)	0.999	1.046 (0.760–1.440)	0.783
Surgery
No	Ref		Ref		Ref
Yes	0.985 (0.385–2.516)	0.974	0.997 (0.420–2.369)	0.995	0.981 (0.385–2.504)	0.969
Unknown	1.745 (0.682–4.462)	0.245	1.684 (0.709–4.002)	0.238	1.760 (0.689–4.492)	0.237

Note: AML, acute myeloid leukemia; CSS, cancer-specific survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 10. Prognostic factors for CSS in children and adolescents with AUL.

Variables	CSS		1-year CSS		5-year CSS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
0–9	Ref		Ref		Ref
10–19	1.653 (1.046–2.612)	0.031	1.602 (1.072–2.393)	0.022	1.658 (1.052–2.612)	0.029
Sex
Female	Ref		Ref		Ref
Male	1.347 (0.857–2.115)	0.196	1.269 (0.849–1.896)	0.246	1.343 (0.856–2.106)	0.199
Race
White	Ref		Ref		Ref
Black	1.223 (0.659–2.273)	0.523	1.263 (0.718–2.221)	0.418	1.218 (0.659–2.253)	0.529
Other	0.174 (0.024–1.272)	0.085	0.182 (0.027–1.219)	0.079	0.168 (0.023–1.235)	0.080
Unknown	4.882 (3.031–7.865)	<0.001	5.148 (3.245–8.167)	<0.001	4.875 (3.029–7.846)	<0.001
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	1.194 (0.580–2.456)	0.630	1.131 (0.591–2.165)	0.710	1.192 (0.580–2.451)	0.632

Note: AUL, acute undifferentiated leukemia; CSS, cancer-specific survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 11. Prognostic factors for CSS in adults with ALL.

Variables	CSS		1-year CSS		5-year CSS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
20–29	Ref		Ref		Ref
30–39	1.186 (1.080–1.302)	<0.001	1.163 (1.074–1.258)	<0.001	1.189 (1.083–1.305)	<0.001
40–49	1.426 (1.301–1.564)	<0.001	1.370 (1.267–1.480)	<0.001	1.434 (1.308–1.573)	<0.001
50–59	1.630 (1.488–1.785)	<0.001	1.528 (1.416–1.650)	<0.001	1.648 (1.505–1.805)	<0.001
60–69	1.898 (1.724–2.090)	<0.001	1.785 (1.645–1.936)	<0.001	1.925 (1.748–2.119)	<0.001
>69	2.463 (2.203–2.753)	<0.001	2.328 (2.119–2.558)	<0.001	2.537 (2.273–2.833)	<0.001
Sex
Female	Ref		Ref		Ref
Male	1.048 (0.989–1.110)	0.113	1.040 (0.990–1.092)	0.118	1.051 (0.992–1.113)	0.090
Race
White	Ref		Ref		Ref
Black	1.241 (1.123–1.372)	<0.001	1.222 (1.124–1.329)	<0.001	1.255 (1.137–1.386)	<0.001
Other	0.931 (0.837–1.036)	0.191	0.961 (0.877–1.053)	0.395	0.934 (0.840–1.038)	0.206
Unknown	0.519 (0.244–1.103)	0.088	0.582 (0.288–1.177)	0.132	0.514 (0.241–1.096)	0.085
Insurance
Uninsured	Ref		Ref		Ref
Insured	0.744 (0.621–0.892)	0.001	0.779 (0.670–0.906)	0.001	0.738 (0.616–0.884)	<0.001
Any Medicaid	1.090 (0.899–1.322)	0.379	1.087 (0.926–1.276)	0.310	1.094 (0.903–1.326)	0.359
Unknown	0.809 (0.677–0.967)	0.020	0.847 (0.729–0.983)	0.029	0.814 (0.681–0.973)	0.024
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	1.439 (1.256–1.648)	<0.001	1.236 (1.097–1.394)	<0.001	1.442 (1.260–1.650)	<0.001
Surgery
No	Ref		Ref		Ref
Yes	0.900 (0.752–1.076)	0.246	0.900 (0.772–1.049)	0.178	0.902 (0.755–1.078)	0.258
Unknown	1.077 (0.887–1.307)	0.454	1.069 (0.906–1.263)	0.428	1.097 (0.904–1.332)	0.346

Note: ALL, acute lymphoblastic leukemia; CSS, cancer-specific survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 12. Prognostic factors for CSS in adults with AML.

Variables	CSS		1-year CSS		5-year CSS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
20–29	Ref		Ref		Ref
30–39	1.074 (0.991–1.163)	0.080	1.069 (0.995–1.149)	0.068	1.075 (0.992–1.165)	0.076
40–49	1.275 (1.184–1.373)	<0.001	1.263 (1.181–1.350)	<0.001	1.279 (1.187–1.378)	<0.001
50–59	1.663 (1.552–1.783)	<0.001	1.619 (1.521–1.724)	<0.001	1.678 (1.565–1.799)	<0.001
60–69	2.058 (1.924–2.202)	<0.001	1.971 (1.855–2.095)	<0.001	2.099 (1.962–2.246)	<0.001
>69	2.743 (2.565–2.933)	<0.001	2.660 (2.505–2.825)	<0.001	2.841 (2.656–3.039)	<0.001
Sex
Female	Ref		Ref		Ref
Male	1.043 (1.014–1.073)	0.003	1.036 (1.010–1.062)	0.006	1.046 (1.017–1.076)	0.002
Race
White	Ref		Ref		Ref
Black	1.086 (1.035–1.141)	<0.001	1.083 (1.038–1.131)	<0.001	1.091 (1.040–1.146)	<0.001
Other	0.991 (0.943–1.041)	0.711	0.994 (0.951–1.038)	0.780	0.992 (0.944–1.042)	0.757
Unknown	0.434 (0.290–0.648)	<0.001	0.455 (0.315–0.657)	<0.001	0.428 (0.286–0.639)	<0.001
Insurance
Uninsured	Ref		Ref		Ref
Insured	0.828 (0.726–0.944)	0.005	0.858 (0.763–0.966)	0.011	0.832 (0.729–0.950)	0.007
Any Medicaid	0.984 (0.855–1.134)	0.827	1.001 (0.882–1.137)	0.983	0.993 (0.861–1.145)	0.926
Unknown	0.969 (0.850–1.104)	0.632	0.971 (0.863–1.092)	0.623	0.973 (0.852–1.110)	0.680
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	0.900 (0.864–0.937)	<0.001	0.839 (0.809–0.870)	<0.001	0.893 (0.858–0.930)	<0.001
Surgery
No	Ref		Ref		Ref
Yes	0.878 (0.637–1.211)	0.428	0.825 (0.615–1.107)	0.200	0.874 (0.634–1.203)	0.408
Unknown	1.045 (0.757–1.442)	0.790	0.976 (0.727–1.311)	0.871	1.052 (0.763–1.450)	0.756

Note: AML, acute myeloid leukemia; CSS, cancer-specific survival; HR, hazard ratio; CI, confidence; Ref, reference.

Table 13. Prognostic factors for CSS in adults with AUL.

Variables	CSS		1-year CSS		5-year CSS
	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Age
20–29	Ref		Ref		Ref
30–39	1.165 (0.829–1.638)	0.378	1.208 (0.898–1.626)	0.212	1.176 (0.833–1.660)	0.357
40–49	1.314 (0.937–1.841)	0.113	1.350 (1.004–1.817)	0.047	1.324 (0.941–1.863)	0.108
50–59	1.708 (1.255–2.326)	<0.001	1.697 (1.297–2.222)	<0.001	1.731 (1.267–2.365)	<0.001
60–69	1.676 (1.244–2.258)	<0.001	1.666 (1.285–2.160)	<0.001	1.722 (1.274–2.328)	<0.001
>69	2.390 (1.784–3.202)	<0.001	2.399 (1.857–3.099)	<0.001	2.476 (1.843–3.328)	<0.001
Sex
Female	Ref		Ref		Ref
Male	0.913 (0.801–1.040)	0.171	0.921 (0.820–1.034)	0.164	0.918 (0.806–1.047)	0.202
Race
White	Ref		Ref		Ref
Black	1.006 (0.793–1.275)	0.961	1.033 (0.839–1.271)	0.761	1.010 (0.797–1.279)	0.937
Other	1.113 (0.824–1.503)	0.485	1.183 (0.903–1.550)	0.223	1.116 (0.826–1.506)	0.475
Unknown	0.343 (0.120–0.984)	0.047	0.361 (0.134–0.974)	0.044	0.338 (0.116–0.980)	0.046
Insurance
Uninsured	Ref		Ref		Ref
Insured	1.022 (0.480–2.177)	0.954	1.099 (0.571–2.114)	0.778	1.021 (0.478–2.183)	0.957
Any Medicaid	1.450 (0.627–3.351)	0.385	1.517 (0.731–3.149)	0.263	1.454 (0.628–3.368)	0.382
Unknown	1.413 (0.688–2.905)	0.346	1.406 (0.755–2.619)	0.283	1.415 (0.686–2.919)	0.348
Chemotherapy
No/unknown	Ref		Ref		Ref
Yes	1.100 (0.945–1.280)	0.217	1.032 (0.902–1.181)	0.646	1.100 (0.946–1.278)	0.216

Note: AUL, acute undifferentiated leukemia; CSS, cancer-specific survival; HR, hazard ratio; CI, confidence; Ref, reference.

Figure 6. Mortality rate of children and adolescents with AL, ALL, AML and AUL. (A) Mortality when AL was the first primary malignancy; (B) mortality when AL was not the first primary malignancy. AL, acute leukemia; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; AUL, acute undifferentiated leukemia; APC, annual percent changes.