Association of socioeconomic status with long-term outcomes in 1-year survivors of allogeneic hematopoietic cell transplantation

Abstract

The relationship of socioeconomic status (SES) with long-term outcomes in allogeneic hematopoietic cell transplantation (HCT) survivors has not been well described. We studied the association of SES with the outcomes of 283 consecutive allogeneic HCT recipients transplanted between 2003 and 2012 who had survived for at least 1 year in remission. Median annual household income was estimated using Census tract data and from ZIP code of residence. SES categories were determined by recursive partitioning analysis (low SES (o $51 000/year), N = 203; high SES (⩾ $51 000/year), N = 80). In multivariable analyses, low SES patients had higher risks of all-cause mortality (hazard ratio (HR) 1.98, P = 0.012) and non-relapse mortality (NRM) (HR 2.22, P = 0.028), but similar risks of relapse mortality (HR 1.01, P = 0.97) compared with high SES patients. A trend toward better survival and lower NRM for high SES patients with no chronic GVHD was observed; low SES patients without GVHD had similar survival as patients with chronic GVHD. In allogeneic HCT survivors who survive in remission for at least 1 year, SES is associated with long-term survival that is primarily mediated through higher risks of NRM. More research is needed to understand the mechanisms of health-care disparities and interventions to mitigate them.

Neighborhood poverty and pediatric allogeneic hematopoietic cell transplantation outcomes: a CIBMTR analysis

“…7 Social determinants of health, including poverty, are widely recognized as major contributors to both adult and pediatric health outcomes in the United States. [8][9][10] While studies in both pediatric oncology [11][12][13][14] and adult HCT [15][16][17] indicate that socioeconomic status is an independent predictor of inferior survival outcomes, including both relapse and overall survival, limited data exist exploring the pertinence of socioeconomic status in pediatric HCT.…”

Association of socioeconomic status with autologous hematopoietic cell transplantation outcomes for lymphoma

“…This is based on an observation made in allogeneic HCT recipients, and corresponds to the transition of patients from transplant centers to community providers and a cohort of patients at high risk for late complications. 22 Patient and disease characteristics were compared by SES using Chi-square or Wilcoxon rank-sum test. OS and PFS were estimated with Kaplan-Meier method and compared with the log-rank test; all other outcomes were estimated with cumulative incidence and compared with the Gray test.…”

Race and socioeconomic status in pediatric allogeneic hematopoietic cell transplantation for nonmalignant conditions

“…Results from studies investigating the impact of SES on outcomes in adult HCT are also inconsistent. While some studies suggest lower SES is associated with worse OS, 20,23 other studies show no difference in clinical outcomes based on various SES indicators 24,25 . The lack of consensus in this growing body of literature is not surprising given the complex interactions between race, SES, and clinical risk factors in HCT recipients.…”