Inferior Access to Allogeneic Transplant in Disadvantaged Populations: A Center for International Blood and Marrow Transplant Research Analysis

Kristjan Paulson, Ruta Brazauskas, Nandita D Khera, Naya He, Navneet Majhail, Gorgun Akpek, Mahmoud Aljurf, D. Buchbinder, L. Burns, Sara Beattie, C. Freytes, Anne Garcia, J. Gajewski, Theresa Hahn, Jennifer Knight, Charles LeMaistre, Hillard Lazarus, D. Szwajcer, Matthew Seftel, Baldeep WirkWilliam Wood, Wael Saber

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalBiology of Blood and Marrow Transplantation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Cell Transplantation
Vulnerable Populations
Bone Marrow
SEER Program
Poverty
Transplants
Myelodysplastic Syndromes
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Research
Acute Myeloid Leukemia
Population
Unrelated Donors
Databases
Costs and Cost Analysis
Incidence

Keywords

  • Access to transplantation
  • Allogeneic transplantation
  • Health services research

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Inferior Access to Allogeneic Transplant in Disadvantaged Populations : A Center for International Blood and Marrow Transplant Research Analysis. / Paulson, Kristjan; Brazauskas, Ruta; Khera, Nandita D; He, Naya; Majhail, Navneet; Akpek, Gorgun; Aljurf, Mahmoud; Buchbinder, D.; Burns, L.; Beattie, Sara; Freytes, C.; Garcia, Anne; Gajewski, J.; Hahn, Theresa; Knight, Jennifer; LeMaistre, Charles; Lazarus, Hillard; Szwajcer, D.; Seftel, Matthew; Wirk, Baldeep; Wood, William; Saber, Wael.

In: Biology of Blood and Marrow Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Paulson, K, Brazauskas, R, Khera, ND, 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 2019, 'Inferior Access to Allogeneic Transplant in Disadvantaged Populations: A Center for International Blood and Marrow Transplant Research Analysis', Biology of Blood and Marrow Transplantation. https://doi.org/10.1016/j.bbmt.2019.06.012
Paulson, Kristjan ; Brazauskas, Ruta ; Khera, Nandita D ; He, Naya ; Majhail, Navneet ; Akpek, Gorgun ; Aljurf, Mahmoud ; Buchbinder, D. ; Burns, L. ; Beattie, Sara ; Freytes, C. ; Garcia, Anne ; Gajewski, J. ; Hahn, Theresa ; Knight, Jennifer ; LeMaistre, Charles ; Lazarus, Hillard ; Szwajcer, D. ; Seftel, Matthew ; Wirk, Baldeep ; Wood, William ; Saber, Wael. / Inferior Access to Allogeneic Transplant in Disadvantaged Populations : A Center for International Blood and Marrow Transplant Research Analysis. In: Biology of Blood and Marrow Transplantation. 2019.
@article{2c7cf41a2c454e38944e439a3ab6ca08,
title = "Inferior Access to Allogeneic Transplant in Disadvantaged Populations: A Center for International Blood and Marrow Transplant Research Analysis",
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.",
keywords = "Access to transplantation, Allogeneic transplantation, Health services research",
author = "Kristjan Paulson and Ruta Brazauskas and Khera, {Nandita D} and Naya He and Navneet Majhail and Gorgun Akpek and Mahmoud Aljurf and D. Buchbinder and L. Burns and Sara Beattie and C. Freytes and Anne Garcia and J. Gajewski and Theresa Hahn and Jennifer Knight and Charles LeMaistre and Hillard Lazarus and D. Szwajcer and Matthew Seftel and Baldeep Wirk and William Wood and Wael Saber",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.bbmt.2019.06.012",
language = "English (US)",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Inferior Access to Allogeneic Transplant in Disadvantaged Populations

T2 - A Center for International Blood and Marrow Transplant Research Analysis

AU - Paulson, Kristjan

AU - Brazauskas, Ruta

AU - Khera, Nandita D

AU - He, Naya

AU - Majhail, Navneet

AU - Akpek, Gorgun

AU - Aljurf, Mahmoud

AU - Buchbinder, D.

AU - Burns, L.

AU - Beattie, Sara

AU - Freytes, C.

AU - Garcia, Anne

AU - Gajewski, J.

AU - Hahn, Theresa

AU - Knight, Jennifer

AU - LeMaistre, Charles

AU - Lazarus, Hillard

AU - Szwajcer, D.

AU - Seftel, Matthew

AU - Wirk, Baldeep

AU - Wood, William

AU - Saber, Wael

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Access to transplantation

KW - Allogeneic transplantation

KW - Health services research

UR - http://www.scopus.com/inward/record.url?scp=85069584418&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069584418&partnerID=8YFLogxK

U2 - 10.1016/j.bbmt.2019.06.012

DO - 10.1016/j.bbmt.2019.06.012

M3 - Article

C2 - 31228584

AN - SCOPUS:85069584418

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

ER -