Impact of race and ethnicity on outcomes and health care utilization after allogeneic hematopoietic cell transplantation

Leuk Lymphoma. 2015 Apr;56(4):987-92. doi: 10.3109/10428194.2014.941834. Epub 2014 Aug 20.

Abstract

Disparities in outcomes after hematopoietic cell transplant (HCT) are reported mostly by registry studies. We examined the association of self-reported race and ethnicity with outcomes and health care utilization after allogeneic HCT in a single center study. Clinical and socioeconomic data of 296 adult patients who underwent allogeneic HCT from November 2003 to October 2012 were analyzed. Survival was compared between non-Hispanic Whites (NHW) and minority patients using Cox proportional hazards regression. Some 73% of patients were NHW and 27% were racial/ethnic minority patients. More minority patients were younger and had lower socioeconomic status. Both unadjusted and adjusted overall and progression-free survival were comparable between the two groups. High risk disease, poor performance score and Medicare/Tricare were significant predictors of mortality. Health care utilization was comparable between the two groups. Homogeneity of medical care for allogeneic HCT may help overcome racial/ethnic disparities, but not those due to patients' primary insurance.

Keywords: Hematopoietic cell transplant; disparities; health care utilization; race/ethnicity.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Asian People / statistics & numerical data
  • Black or African American / statistics & numerical data
  • Disease-Free Survival
  • Female
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data*
  • Hematopoietic Stem Cell Transplantation / ethnology
  • Hematopoietic Stem Cell Transplantation / methods
  • Hematopoietic Stem Cell Transplantation / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Indians, North American / statistics & numerical data
  • Leukemia / ethnology
  • Leukemia / therapy
  • Lymphoma / ethnology
  • Lymphoma / therapy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myelodysplastic Syndromes / ethnology
  • Myelodysplastic Syndromes / therapy
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Patient Acceptance of Health Care / ethnology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Proportional Hazards Models
  • Socioeconomic Factors
  • Transplantation, Homologous
  • White People / statistics & numerical data
  • Young Adult