Florida Leukemia Rates Rising Rapidly as Population Ages
Florida Leads U.S. in Leukemia Rates, But Specialized Care is Out of Reach for Some of the Hardest-Hit Communities
Driven by a steady influx of retirees, Florida now has the highest leukemia rates of any U.S. state and the disease is the fastest-rising cancer type statewide, according to new research from Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine.
The study, published in Blood Neoplasia, also identified a problematic mismatch between the location of Florida’s leukemia “hotspots” and the availability of comprehensive leukemia treatment. Predominantly Black communities experienced higher leukemia mortality rates and were less likely to have access to nearby treatment services, the researchers noted. These findings have wide-ranging implications for health care planning in the decades ahead, both in Florida and nationwide, as the U.S. population keeps aging.
Leukemia
There are about 63,000 new cases of leukemia in the United States each year, and leukemia accounts for about 3% of U.S. cancer deaths. Treatments have improved in recent decades, and for young people, survival rates in acute myeloid leukemia average around 60%. For adults, the five-year survival rate drops to 35%. And for adults over 65 years of age, one-year survival drops to 20%.
That’s partly because younger people can tolerate more intensive treatments, such as stem cell therapies and bone marrow transplants. The disease also presents differently in older people, “almost like a different disease entirely,” said Justin Taylor, M.D., an associate professor in hematology specializing in leukemia treatment and research. He led the study.
Leukemias are relatively rare, accounting for only about 12% of cancer diagnoses in the U.S. But while reviewing cancer data from Sylvester’s Scan360 tools, Taylor noticed that leukemia had moved to the top of the list for the fastest-increasing cancer in Florida. He then looked further afield and found that Florida has the highest rates of leukemia in the U.S.
“Why is it increasing so fast?” Taylor asked. “Are we missing something?”
An Older Florida is More at Risk
To explore leukemia trends in Florida, Taylor and his team looked at leukemia cases from 2000-2019, sorted by patient demographics and broken down into counties for geographic analyses. The researchers looked for hotspots with higher-than-average mortality rates, divided the data by race/ethnicity, and added factors such as income and health insurance status.
Age, already a known risk factor for leukemia, was a primary driver of leukemia trends in the state. Most leukemia patients nationally are older because genetic mutations in bone marrow cause leukemia. As we age, we collect mutations. If the wrong mutation lands in a leukemia-related gene, the disease could develop. More years means more mutations and a higher likelihood of the unlucky combination.
Taylor and his team’s analyses found that cases of leukemia in older adults were higher between 2010 and 2019 than in the previous decade, and that increase was driven largely by out-of-state retirees moving into the Sunshine state. (The survival rate also ticked up slightly over that time.)
Mapping Florida’s Leukemia Cases and Care
The researchers also carefully mapped every doctor and practice that treats leukemia and then compared those provider locations to the leukemia mortality hotspots. Most of the hotspots were more than 30 miles from a leukemia care provider, and the hotspots tended to be in more rural locations.
“There are no leukemia treatment providers in any of the areas with the greatest need,” Taylor said. He posed several hypotheses on how this could affect discrepancies in the quality and timing of care leukemia patients receive: Low-income patients, for instance, might be less able to take time off from work to drive to a distant clinic for frequent visits. They might turn to non-specialist doctors, who might misdiagnose or begin inappropriate treatment. Or the correct diagnosis might get made but at a later stage.
The distance between hotspots and healthcare locations impacts groups differently. Hotspots tended to have more non-Hispanic Black patients. Those patients also had higher overall mortality rates than non-Hispanic White patients, although the latter group had a greater frequency of leukemia cases overall.
Next steps
By understanding more fully Florida’s leukemia health care, the findings highlighted opportunities. “You don’t want to just point out problems. You want to offer solutions,” Taylor said. Satellite campuses of large health care institutes can provide critical access to more remote populations, and telehealth has enabled faster, easier diagnosis and regular check-ins with patients, he added. Finding where there are discrepancies can inform doctor allocation in a health care world that is often short-staffed.
The study warrants attention beyond Florida. “This is something we should be paying attention to,” Taylor said. “Florida has a very heterogeneous population and an aging population. That reflects how much of the U.S. will look in 50 years. And in general, with an older population, we’ll see more leukemia. In that sense, Florida is a bellwether for the rest of the country.”
Justin Taylor, M.D. will be speaking at the 4th Biennial Miami Leukemia Symposium, April 25-27.
