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

Abstract

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.

Social determinants of health predict health outcomes following pediatric allogeneic hematopoietic stem cell transplant

“…The findings of this study have substantial implications in clinical practice. Routine assessments should be conducted early and often throughout the pediatric HCT course to identify patients and families who are at risk of disparate medical outcomes related to SDoH 21 . Such assessments could be used to tailor the interventions and resources provided to patients and families by a multidisciplinary team.…”

Do Racial and Ethnic Disparities Exist in Management of Pediatric Mandible Fractures? A 30-Year Outcome Analysis

“…Pediatric surgery studies reporting this outcome are particularly sparse. Harney et al 25 reported no racial disparities in pediatric allogeneic hematopoietic cell transplantation for nonmalignant conditions and suggested that this could be due to the mitigation of typical drivers of racial health disparities at their tertiary care center through access to high-quality medical and supportive care. Similarly, our institution offers services such patient education, transportation assistance, trained interpreters, and financial support.…”

Social determinants of health and primary immunodeficiency

“…112 A multidisciplinary approach including psychosocial and sociodemographic assessments can help mitigate these challenges. 113 Data from the Center for International Blood and Marrow Transplant Research suggest inferior access to transplantation for adult Americans with lymphoproliferative disease who come from disadvantaged areas. 114 Nevertheless, there are no data on the effect of health coverage status on access to transplantation.…”