Social determinants of health and access to allogeneic hematopoietic cell transplantation for acute myeloid leukemia
Abstract
Abstract Whether allogeneic hematopoietic cell transplant (allo-HCT) to treat acute myeloid leukemia (AML) is equitably accessible regardless of social determinants of health (SDOH) remains unknown. We examined associations of SDOH with access to allo-HCT and other outcomes. Patients presenting for treatment (n = 692) at 13 AML treatment centers were prospectively recruited to a registered clinical trial (number NCT01929408). Various patient-, AML-, and SDOH-specific variables were collected. Outcomes included mortality without allo-HCT, receipt of allo-HCT, and mortality after allo-HCT. Individual multivariable models (Fine-Gray for the first 2 outcomes, Cox regression for the third) were fit for each SDOH variable, adjusting for relevant patient- and AML-specific variables. Allo-HCT was used to treat 46% of patients. A 10% increase in the proportion with less than a high school education, in households receiving Supplemental Nutrition Assistance Program, receiving Supplemental Security Income, or in poverty led to modeled adjusted hazard ratios (aHRs) of 1.21 (0.99-1.46), 1.13 (0.97-1.31), 1.41 (1.01-1.97), and 1.16 (0.96-1.39) for death without allo-HCT. The aHRs were 0.67 (0.55-0.83), 0.88 (0.76-1.01), 0.71 (0.48-1.05), and 0.91 (0.75-1.09) for lessened receipt of allo-HCT. Among those who received allo-HCT, aHRs for mortality were 1.18 (0.87-1.60), 1.13 (0.92-1.38), 1.21 (0.81-1.82), and 1.04 (0.79-1.36). Results highlight increased mortality without allo-HCT and decreased access to allo-HCT, but lesser magnitude of increased mortality after allo-HCT, among patients from lower resourced areas due to limited education and/or increased poverty. Targeted interventions and policy changes are needed to ensure that marginalized patient populations have equitable chances for AML cure compared with others.
Article Details
Authors (25)
Natalie Wuliji
1Fred Hutchinson Cancer Center, SEATTLE, United States
Salene M. W. Jones
3Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA
Ted Gooley
Aaron T. Gerds
4Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
Bruno C. Medeiros
5Division of Hematology, Department of Medicine, Stanford University, Stanford, Palo Alto, CA
Paul J. Shami
32Division of Hematology and Hematologic Malignancies, University of Utah Huntsman Cancer Institute, Salt Lake City, UT
John Galvin
4Incyte Corporation, Wilmington, United States
Kehinde Adekola
8Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
Selina Luger
14University of Pennsylvania/ Abrahmson Cancer Center, Philadelphia, United States
Maria R. Baer
10University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
David Rizzieri
6Novant Health Cancer Institute, Charlotte, United States
Tanya M. Wildes
12Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE
Eunice S. Wang
30Roswell Park Cancer Institute, Buffalo, NY
Mikkael A. Sekeres
14University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
Sudipto Mukherjee
1Cleveland Clinic, Internal Medicine, Cleveland, United States
Julie Smith
1Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, United States
Mitchell Garrison
15Confluence Health/Wenatchee Valley Hospital and Clinic, Wenatchee, WA
Kiarash Kojouri
16Skagit Valley Hospital, Mount Vernon, WA
Jacob Appelbaum
1University of Washington, Medicine (Hematology/Oncology), Seattle, United States
Mary-Elizabeth Percival
1University of Washington, Medicine (Hematology/Oncology), Seattle, United States
Brenda M. Sandmaier
2Division of Hematology and Oncology, University of Washington School of Medicine, Seattle, WA
Stephanie Lee
Frederick R. Appelbaum
1Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
Rayne Rouce
18Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
Mohamed L. Sorror
1Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA