Frailty and health resource utilization in 5450 adults with acute myeloid leukaemia: a population-based study from Ontario, Canada

Frailty is a recognized prognostic factor in acute myeloid leukaemia (AML), yet its independent impact on healthcare resource utilization remains understudied. This study evaluated frailty’s association with healthcare resource utilization (HRU) burden during the first year of AML treatment. We conducted a population-based retrospective cohort study using linked administrative databases in Ontario, Canada, involving 5450 AML adults (2006–2023) initiating chemotherapy. Frailty was assessed via a validated deficit-accumulation index. HRU outcomes—total-length of stay (LOS), intensive care unit (ICU)-LOS and hospital/emergency department (ED) visits—were measured as rates per person-year and their association with frailty measured as rate ratio (RR) using multivariable negative binomial regression, adjusting for age, sex and chemotherapy intensity. Frailty was independently associated with significantly higher HRU intensity. Compared to fit patients, frail patients demonstrated increased rates of total-LOS (RR 1.18), hospital/ED visits (RR 1.12) and, notably, ICU-LOS (RR 1.81). Conversely, advanced chronological age (≥65 years) correlated with lower ICU utilization (RR 0.60), suggesting critical care decisions may be more age-driven than based on physiological reserve. Frailty is a driver of HRU in AML, superiorly predicting high-acuity resource needs compared to chronological age. Routine frailty assessments are essential to inform resource allocation, guide treatment intensity, mitigate triage bias and improve value-based care.