Analysis of readmission rates, length of stay and mortality among bone marrow transplant and CAR-T patients in a rural state.

Abstract

e19021 Background: Bone marrow transplantation (BMT) and chimeric antigen receptor T-cell (CAR-T) therapy has become an integral treatment modality for several hematological malignancies and disorders. However, its research in rural states where healthcare disparity is common remains understudied. Methods: This retrospective cohort study analyzed patient data between 2015-2022 at a single academic institution that serves as the only BMT/CAR-T facility in a rural state. Patients were divided into black and white races given very low sample size for other races. Socioeconomic factors, demographics, comorbidities, and insurance status were analyzed. Univariable and multivariable regression models were used to assess the association between race, readmissions, length of stay (LOS), and mortality in these patients. P-value <0.05 was considered significant. Results: Altogether 1,496 patients were included in the study. Of these, 297 identified as black, 1,127 as white, and 72 as other races. A total of 1,157 of these patients had undergone auto-BMT, 87 allo-transplantation, and 52 auto-CAR-T. LOS differed significantly based on the type of BMT and primary insurance (p < 0.001). These effects were observed even when controlling for other demographic variables and when nonparametric, tree-based multivariable models are used. Patients undergoing allo-transplantation had a much longer LOS than auto-BMT and auto-CAR-T patients. On the same note, patients who had private insurance had a much lower LOS than the other groups. In terms of mortality, when adjusting for variables such as age, results indicated that there was a significant difference in 90-day mortality based upon primary insurance (p = 0.024), with Medicare patients having worse outcomes. Additionally, type of therapy received was also significantly associated with 90-day mortality when adjusting for other covariates (p < 0.001). Re-admission rates differed significantly depending on type of treatment received (30-day: p = 0.007, 90-day, p < 0.001). Gender was also found to be statistically significant for 90-day readmission rate (p = 0.010), with females having higher readmission numbers than males. Overall, allo-transplantation patients had higher 30 & 90-day readmission numbers than the other transplant groups. Conclusions: This study highlights disparities that exist especially in rural states where resources are limited for patient care. Type of transplantation, and primary insurance play crucial roles in the length of stay, readmission and mortality of patients undergoing BMT or CAR-T treatment. Addressing the disparities may require improved access to focused interventions.