Abstract
Abstract 4309
We investigated an apparent increase in acute lymphoblastic leukemia (ALL) referral from north Georgia to Emory University Hospital, a tertiary care center located in Atlanta, Georgia. Cases reported between 1999 and 2008 to the Georgia Comprehensive Cancer Registry (GCCR) and the national Surveillance Epidemiology and End Results (SEER) cancer registry were analyzed. Age-adjusted incidence rates were calculated for all counties and public health regions within the state of Georgia and compared to national rates calculated using SEER 17 data for those ages 20 and above. Cases of adult acute myeloid leukemia (AML) served as control for health referral patterns, completeness of data collection and healthcare availability. The associations between geographic residence and acute leukemia were analyzed using Poisson regression analysis, and additional models were created to control for the effects of race and ethnicity. The age-adjusted incidence rate of adult ALL (0.8/100,000) and AML (4.6/100,000) for the state of Georgia were comparable to the national rates (0.9/100,000 and 5.2/100,000 respectively). Overall, the rate of ALL observed in parts of the North Georgia region (1.1 (95% CI 0.8, 1.5) were similar when compared to the rest of the state; and not affected after adjusting for race. We conclude that the higher number of cases of ALL cases referred from North Georgia is likely related to a physician-related referral pattern rather than an increased incidence.
Age-adjusted incidence rate of ALL by state and public health region and rate ratios comparing the rate of ALL within each region to the pooled rates demonstrated in all other Georgia public health regions.
| Region of Georgia (GA) . | Rate . | SE . | Lower CI . | Upper CI . | Count . | Pop . |
|---|---|---|---|---|---|---|
| GA: Clayton (Jonesboro) | 1.1 | 0.3 | 0.6 | 1.8 | 17 | 1,715,865 |
| GA: DeKalb | 0.8 | 0.1 | 0.5 | 1.1 | 37 | 5,111,685 |
| GA: Fulton | 0.6 | 0.1 | 0.4 | 0.8 | 37 | 6,565,834 |
| GA: Northwest (Rome) | 0.9 | 0.1 | 0.6 | 1.2 | 35 | 3,962,399 |
| GA: North Georgia (Dalton) | 0.9 | 0.2 | 0.6 | 1.4 | 23 | 2,632,276 |
| GA: North (Gainesville) | 1.1 | 0.2 | 0.8 | 1.5 | 41 | 3,723,276 |
| GA: Cobb-Douglas | 0.8 | 0.1 | 0.5 | 1.1 | 38 | 5,357,377 |
| GA: Gwinnett | 0.7 | 0.1 | 0.5 | 1 | 38 | 5,712,772 |
| GA: LaGrange | 0.8 | 0.1 | 0.5 | 1.1 | 37 | 4,818,090 |
| GA: South Central (Dublin) | 0.3 | 0.2 | 0.1 | 0.9 | 4 | 1,009,356 |
| GA: North Central (Macon) | 0.7 | 0.1 | 0.4 | 1 | 24 | 3,476,472 |
| GA: East Central (Augusta) | 0.7 | 0.2 | 0.4 | 1.1 | 20 | 3,017,677 |
| GA: West Central (Columbus) | 0.6 | 0.2 | 0.3 | 1 | 14 | 2,492,172 |
| GA: South (Valdosta) | 0.3 | 0.1 | 0.1 | 0.8 | 5 | 1,638,741 |
| GA: Southwest (Albany) | 0.9 | 0.2 | 0.5 | 1.3 | 22 | 2,500,405 |
| GA: Coastal (Savannah) | 0.8 | 0.2 | 0.6 | 1.2 | 29 | 3,568,163 |
| GA: Northeast (Athens) | 0.9 | 0.2 | 0.6 | 1.3 | 26 | 2,903,745 |
| GA: All Georgia | 0.8 | 0 | 0.7 | 0.8 | 463 | 62,540,286 |
| Region of Georgia (GA) . | Rate . | SE . | Lower CI . | Upper CI . | Count . | Pop . |
|---|---|---|---|---|---|---|
| GA: Clayton (Jonesboro) | 1.1 | 0.3 | 0.6 | 1.8 | 17 | 1,715,865 |
| GA: DeKalb | 0.8 | 0.1 | 0.5 | 1.1 | 37 | 5,111,685 |
| GA: Fulton | 0.6 | 0.1 | 0.4 | 0.8 | 37 | 6,565,834 |
| GA: Northwest (Rome) | 0.9 | 0.1 | 0.6 | 1.2 | 35 | 3,962,399 |
| GA: North Georgia (Dalton) | 0.9 | 0.2 | 0.6 | 1.4 | 23 | 2,632,276 |
| GA: North (Gainesville) | 1.1 | 0.2 | 0.8 | 1.5 | 41 | 3,723,276 |
| GA: Cobb-Douglas | 0.8 | 0.1 | 0.5 | 1.1 | 38 | 5,357,377 |
| GA: Gwinnett | 0.7 | 0.1 | 0.5 | 1 | 38 | 5,712,772 |
| GA: LaGrange | 0.8 | 0.1 | 0.5 | 1.1 | 37 | 4,818,090 |
| GA: South Central (Dublin) | 0.3 | 0.2 | 0.1 | 0.9 | 4 | 1,009,356 |
| GA: North Central (Macon) | 0.7 | 0.1 | 0.4 | 1 | 24 | 3,476,472 |
| GA: East Central (Augusta) | 0.7 | 0.2 | 0.4 | 1.1 | 20 | 3,017,677 |
| GA: West Central (Columbus) | 0.6 | 0.2 | 0.3 | 1 | 14 | 2,492,172 |
| GA: South (Valdosta) | 0.3 | 0.1 | 0.1 | 0.8 | 5 | 1,638,741 |
| GA: Southwest (Albany) | 0.9 | 0.2 | 0.5 | 1.3 | 22 | 2,500,405 |
| GA: Coastal (Savannah) | 0.8 | 0.2 | 0.6 | 1.2 | 29 | 3,568,163 |
| GA: Northeast (Athens) | 0.9 | 0.2 | 0.6 | 1.3 | 26 | 2,903,745 |
| GA: All Georgia | 0.8 | 0 | 0.7 | 0.8 | 463 | 62,540,286 |
Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25–1130) standard; Confidence intervals (Tiwari mod) are 95% for rates.
Waller:Outsuka: Research Funding.
Author notes
Asterisk with author names denotes non-ASH members.
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