Faculty Collaboration Database

Community health status and outcomes after allogeneic hematopoietic cell transplantation in the United States. Cancer 2021 Feb 15;127(4):609-618

Date

10/22/2020

Pubmed ID

33085090

Pubmed Central ID

PMC7855526

DOI

10.1002/cncr.33232

Scopus ID

2-s2.0-85092920705 (requires institutional sign-in at Scopus site)   11 Citations

Abstract

BACKGROUND: The association of community factors and outcomes after hematopoietic cell transplantation (HCT) has not been comprehensively described. Using the County Health Rankings and Roadmaps (CHRR) and the Center for International Blood and Marrow Transplant Research (CIBMTR), this study evaluated the impact of community health status on allogeneic HCT outcomes.

METHODS: This study included 18,544 adult allogeneic HCT recipients reported to the CIBMTR by 170 US centers in 2014-2016. Sociodemographic, environmental, and community indicators were derived from the CHRR, an aggregate community risk score was created, and scores were assigned to each patient (patient community risk score [PCS]) and transplant center (center community risk score [CCS]). Higher scores indicated less healthy communities. The impact of PCS and CCS on patient outcomes after allogeneic HCT was studied.

RESULTS: The median age was 55 years (range, 18-83 years). The median PCS was -0.21 (range, -1.37 to 2.10; standard deviation [SD], 0.42), and the median CCS was -0.13 (range, -1.04 to 0.96; SD, 0.40). In multivariable analyses, a higher PCS was associated with inferior survival (hazard ratio [HR] per 1 SD increase, 1.04; 99% CI, 1.00-1.08; P = .0089). Among hematologic malignancies, a tendency toward inferior survival was observed with a higher PCS (HR, 1.04; 99% CI, 1.00-1.08; P = .0102); a higher PCS was associated with higher nonrelapse mortality (NRM; HR, 1.08; 99% CI, 1.02-1.15; P = .0004). CCS was not significantly associated with survival, relapse, or NRM.

CONCLUSIONS: Patients residing in counties with a worse community health status have inferior survival as a result of an increased risk of NRM after allogeneic HCT. There was no association between the community health status of the transplant center location and allogeneic HCT outcomes.

Author List

Hong S, Brazauskas R, Hebert KM, Ganguly S, Abdel-Azim H, Diaz MA, Beattie S, Ciurea SO, Szwajcer D, Badawy SM, Gratwohl AA, LeMaistre C, Aljurf MDSM, Olsson RF, Bhatt NS, Farhadfar N, Yared JA, Yoshimi A, Seo S, Gergis U, Beitinjaneh AM, Sharma A, Lazarus H, Law J, Ulrickson M, Hashem H, Schoemans H, Cerny J, Rizzieri D, Savani BN, Kamble RT, Shaw BE, Khera N, Wood WA, Hashmi S, Hahn T, Lee SJ, Rizzo JD, Majhail NS, Saber W

Authors

Ruta Brazauskas PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
J. Douglas Rizzo MD, MS Director, Center Associate Director, Professor in the Medicine department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin
Bronwen E. Shaw MBChB, PhD Center Director, Professor in the Medicine department at Medical College of Wisconsin

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

Adolescent
Adult
Aged
Aged, 80 and over
Community Health Planning
Female
Hematologic Neoplasms
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Public Health
Risk Factors
Transplantation, Homologous
Treatment Outcome
United States
Young Adult