Geographic access to hematopoietic cell transplantation services in the United States

Delamater, Paul L.; Uberti, Joseph P.

doi:10.1038/bmt.2015.246

Cited by 24 publications

(14 citation statements)

References 17 publications

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“…Prior studies suggest that families travel significant distances (average 60–100 miles) for specialized pediatric care. 21–23 We called all listed providers from the BCBS website that met our criteria. We did not restrict our search to providers listed as accepting new patients in order to maximize our sample size.…”

Section: Methodsmentioning

confidence: 99%

Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities

et al. 2017

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The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. Providers were less likely to have available appointments for children on Medicaid, which is public insurance for low-income people. The most common reason for being unable to make an appointment was that the listed phone number was incorrect. Pediatricians were twice as likely to see new patients and to see them sooner than child psychiatrists. Increasing the number of both types of providers may be necessary to increase access to mental health care for children.

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Section: Methodsmentioning

confidence: 99%

Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities

et al. 2017

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“…One small study examining access to stem cell transplantation in Canada found rural patients were somewhat less likely to receive an autologous HCT compared with urban patients, although this difference was not statistically significant, possibly due to small numbers [3]. A recent study found that the majority of Americans are located within reasonable driving distance of a stem cell transplantation center (78.6% within a 90-minute drive, 94.7% within a 180-minute drive) [4]. Although that study might suggest that physical geography is not a significant barrier to transplantation, it did not attempt to compare transplantation rates between rural and urban Americans, or to examine how transplantation rates vary by other sociodemographic variables.…”

Section: Introductionmentioning

confidence: 99%

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

Paulson

Brazauskas

Khera

et al. 2019

Biology of Blood and Marrow Transplantation

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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.

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“…Stem cell transplantation is a highly specialized treatment that is only available at a limited number of pediatric facilities in the United States 33 . Recent studies suggest that access to HCT may differ by race and SES, 34,35 a phenomenon at least partially driven by racial/ethnic differences in donor availability.…”

Section: Discussionmentioning

confidence: 99%

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

Harney

Kahn

Jin

et al. 2020

Pediatric Blood & Cancer

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Background Survival disparities by race/ethnicity and socioeconomic status (SES) are observed in a wide range of pediatric treatment settings including oncology and solid organ transplantation. To date, few studies have examined the effects of race and SES on outcomes in pediatric allogeneic hematopoietic cell transplantation (HCT). We explored whether survival differed by race/ethnicity or SES in children receiving HCT for nonmalignant conditions at a single institution serving a diverse patient population. Procedures The Kaplan‐Meier method was used to estimate overall survival (OS) with the log‐rank test for between‐group comparisons. Cox proportional hazards models were used to identify risk factors for OS, adjusting for treatment‐ and disease‐related factors. Results Of 133 subjects, 0 to 21 years, 19% were non‐Hispanic (NH) white, 34% were NH black, 40% were Hispanic, and 7% were Asian. Sixty‐seven percent of the subjects had public insurance; 49% lived in neighborhoods with poverty rate ≥20%. Primary diagnoses included hemoglobinopathies (56%), bone marrow failure (22%), and other conditions (22%). Median follow‐up was 5.8 years (range 0.1‐14.5). Analysis revealed no difference in OS by race, insurance type, or neighborhood SES. Conclusions Findings from this single‐institution study suggest that in pediatric patients undergoing HCT for nonmalignant conditions, treatment at a tertiary care center with a multidisciplinary approach may mitigate drivers of disparities observed in other settings. Additional studies are now needed to further elucidate the complex interrelationships among race, SES, and clinical outcomes for children undergoing HCT.

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Geographic access to hematopoietic cell transplantation services in the United States

Cited by 24 publications

References 17 publications

Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities

Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities

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

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

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