Faculty Collaboration Database

Neighborhood poverty and pediatric allogeneic hematopoietic cell transplantation outcomes: a CIBMTR analysis. Blood 2021 Jan 28;137(4):556-568

Date

10/27/2020

Pubmed ID

33104215

Pubmed Central ID

PMC7845011

DOI

10.1182/blood.2020006252

Scopus ID

2-s2.0-85099936348 (requires institutional sign-in at Scopus site)   33 Citations

Abstract

Social determinants of health, including poverty, contribute significantly to health outcomes in the United States; however, their impact on pediatric hematopoietic cell transplantation (HCT) outcomes is poorly understood. We aimed to identify the association between neighborhood poverty and HCT outcomes for pediatric allogeneic HCT recipients in the Center for International Blood and Marrow Transplant Research database. We assembled 2 pediatric cohorts undergoing first allogeneic HCT from 2006 to 2015 at age ≤18 years, including 2053 children with malignant disease and 1696 children with nonmalignant disease. Neighborhood poverty exposure was defined a priori per the US Census definition as living in a high-poverty ZIP code (≥20% of persons below 100% federal poverty level) and used as the primary predictor in all analyses. Our primary outcome was overall survival (OS), defined as the time from HCT until death resulting from any cause. Secondary outcomes included relapse and transplantation-related mortality (TRM) in malignant disease, acute and chronic graft-versus-host disease, and infection in the first 100 days post-HCT. Among children undergoing transplantation for nonmalignant disease, neighborhood poverty was not associated with any HCT outcome. Among children undergoing transplantation for malignant disease, neighborhood poverty conferred an increased risk of TRM but was not associated with inferior OS or any other transplantation outcome. Among children with malignant disease, a key secondary finding was that children with Medicaid insurance experienced inferior OS and increased TRM compared with those with private insurance. These data suggest opportunities for future investigation of the effects of household-level poverty exposure on HCT outcomes in pediatric malignant disease to inform care delivery interventions.

Author List

Bona K, Brazauskas R, He N, Lehmann L, Abdel-Azim H, Ahmed IA, Al-Homsi AS, Aljurf M, Arnold SD, Badawy SM, Battiwalla M, Beattie S, Bhatt NS, Dalal J, Dandoy CE, Diaz MA, Frangoul HA, Freytes CO, Ganguly S, George B, Gomez-Almaguer D, Hahn T, Kamble RT, Knight JM, LeMaistre CF, Law J, Lazarus HM, Majhail NS, Olsson RF, Preussler J, Savani BN, Schears R, Seo S, Sharma A, Srivastava A, Steinberg A, Szwajcer D, Wirk B, Yoshimi A, Khera N, Wood WA, Hashmi S, Duncan CN, 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

Adolescent
Cause of Death
Child
Child, Preschool
Chronic Disease
Databases, Factual
Female
Follow-Up Studies
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Infant
Insurance Coverage
Male
Medicaid
Neoplasms
Poverty
Recurrence
Social Determinants of Health
Survival Analysis
Transplantation, Homologous
Treatment Outcome
United States