Faculty Collaboration Database

Inferior Access to Allogeneic Transplant in Disadvantaged Populations: A Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant 2019 Oct;25(10):2086-2090

Date

06/23/2019

Pubmed ID

31228584

Pubmed Central ID

PMC7292490

DOI

10.1016/j.bbmt.2019.06.012

Scopus ID

2-s2.0-85069584418 (requires institutional sign-in at Scopus site)   40 Citations

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) is offered in a limited number of medical centers and is associated with significant direct and indirect costs. The degree to which social and geographic barriers reduce access to alloHCT is unknown. Data from the Surveillance, Epidemiology and End Results Program (SEER) and the Center for International Blood and Marrow Transplant Research (CIBMTR) were integrated to determine the rate of unrelated donor (URD) alloHCT for acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS) performed between 2000 and 2010 in the 612 counties covered by SEER. The total incidence of AML, ALL, and MDS was determined using SEER, and the number of alloHCTs performed in the same time period and geographic area were determined using the CIBMTR database. We then determined which sociodemographic attributes influenced the rate of alloHCT (rural/urban status, median family size, percentage of residents below the poverty line, and percentage of minority race). In the entire cohort, higher levels of poverty were associated with lower rates of alloHCT (estimated rate ratio [ERR], .86 for a 10% increase in the percentage of the population below the poverty line; P < .01), whereas rural location was not (ERR, .87; P = .11). Thus, patients from areas with higher poverty rates diagnosed with ALL, AML, and MDS are less likely patients from wealthier counties to undergo URD alloHCT. There is need to better understand the reasons for this disparity and to encourage policy and advocacy efforts to improve access to medical care for all.

Author List

Paulson K, Brazauskas R, Khera N, He N, Majhail N, Akpek G, Aljurf M, Buchbinder D, Burns L, Beattie S, Freytes C, Garcia A, Gajewski J, Hahn T, Knight J, LeMaistre C, Lazarus H, Szwajcer D, Seftel M, Wirk B, Wood W, Saber W

Authors

Ruta Brazauskas PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Jennifer M. Knight MD, MS Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Transplantation Conditioning
Transplantation, Homologous