Hematopoietic stem cell transplantation among patients with leukemia of all ages in Texas

Abstract

BACKGROUNDHematopoietic stem cell transplantation (HSCT) is an effective but expensive medical procedure to which some ethnic minorities, the elderly, and those without insurance have been shown to have limited access. The purpose of the current study was to determine whether socioeconomic factors were associated with HSCT usage rates in patients with leukemia.METHODSThe authors identified 6574 patients with acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myelogenous leukeima, chronic myelogenous leukemia, or other leukemias from the 1999 Texas Hospital Inpatient Discharge Public Use Data File. Of these patients, 1604 received an autologous or allogeneic HSCT. The authors assessed patients' ethnicity, payer status, age, gender, and comorbid medical conditions. Logistic regression was used to control for patient characteristics and to evaluate associations among payer status, ethnicity, and HSCT use. P ≤ 0.05 indicated statistical significance.RESULTSPatients who self‐paid had the highest rate of HSCT use in all age groups (32%; P ≤ 0.01) and in the adult group (36%; P = 0.11). Elderly patients with Medicare had a low rate of HSCT use (17%; P = 0.13). Logistic regression showed no statistically significant associations between payer status or ethnicity and HSCT use. However, elderly women were significantly less likely to undergo HSCT than elderly men (odds ratio, 0.34; P ≤ 0.01).CONCLUSIONSThe lack of statistically significant differences in HSCT use among adult patients with leukemia was surprising because previous studies had shown differences in HSCT by ethnicity and insurance. Cancer 2004. © 2004 American Cancer Society.

Sociodemographic disparities in chemotherapy and hematopoietic cell transplantation utilization among adult acute lymphoblastic and acute myeloid leukemia patients

“…Consistent with findings made by others [10,14], chemotherapy and HCT utilization reported here were lowest among older acute leukemia patients with further reduced treatment utilization observed among older patients that were not married. Reasons for reduced utilization of HCT in older patients may include lower suitability for chemotherapy and HCT because of poor performance status, increased acuity at presentation, and comorbidities that lower tolerance for aggressive treatment [36], although physician biases and nihilism [9] regarding the value of chemotherapy and HCT in the older population may also play a role despite growing evidence that the older population can benefit from chemotherapy and HCT.…”

“…Multivariable analyses of HCT utilization among acute leukemia patients using hospital discharge data for 1988 and 1991 showed that odds of HCT for acute leukemia were negatively influenced by older age, black race, self-pay status, Medicaid insurance, and HMO insurance 10 . In contrast, a large study using Texas hospital discharge data from 1999 found no difference in utilization of HCT based on race or insurance status [14]. Evaluating more recent data, Joshua et al .…”

Tertiary center referral patterns for patients with myelodysplastic syndrome are indicative of age and race disparities: a single-institution experience

“…Previous studies have examined access to transplants in patients with leukemia, lymphoma and multiple myeloma by race. There are conflicting data in the literature, vwth less frequent transplants in black patients in some studies [22,23], but not others [24]. Of note, these prior studies did not include patients with MDS.…”

Who is fit for allogeneic transplantation?

“…85 This was confirmed in a second study, 86 although another report found no difference. 87 However, once the patient is referred for HCT, how would black race lead to a negative impact on transplantation outcome? [88][89][90] In an analysis of 2221 allogeneic transplantation recipients, black race was associated with significantly higher mortality rates than observed in whites (HR ϭ 1.65).…”