Impact of High-Altitude Hypoxia on Mortality from Acute Lymphoblastic Leukemia in Mountain Regions of Ecuador

Purpose: Acute lymphoblastic leukemia (ALL) is a rare hematological cancer that primary affects children, although its prognosis for survival is better than that of ALL in adults. We investigated the possibility that hypoxia brought on by high altitude might be an AAL-death risk factor by examininghow altitude could modify age-dependent pattern of ALL-mortality. Methods: In Ecuador, an epidemiological investigation was conducted to examine the spatial distribution of ALL mortality by sex and age in relation to altitude. The sample was divided into children (≤ 17 years old) and adults (≥ 18 years old), in addition to sex as a differentiator. ALL age-adjusted mortality rates per 100,000 inhabitants were calculated from 2011 to 2022. Relative Risk was computed to estimate the likelihood of ALL-death for both pediatric and adult groups across altitude categories. For comparisons based on sex, the t -test was applied. Results: When ALL-death rates was analyzed by altitude, the current investigation revealed significant age differences. Adults who lived over 2000 m were almost twice as likely to die from ALL as those who lived at sea level. Low and moderately high altitudes (1000-2000 m) provided a protective benefit in the pediatric group (only boys), while elevations beyond 2000 m appeared to eliminate this effect. Conclusions: Our results highlight altitude as a biometeorological factor influencing ALL mortality. ALL mortality rates were negatively impacted by altitude. Children could be harmed by hypoxia at elevations higher than 2000 m above sea level, although the effect was worse in adults. Our results support the emerging notion that hypoxia-inducible factor pathway contributes to ALL.