4.7 Article

Neighborhood poverty and pediatric allogeneic hematopoietic cell transplantation outcomes: a CIBMTR analysis

期刊

BLOOD
卷 137, 期 4, 页码 556-568

出版社

AMER SOC HEMATOLOGY
DOI: 10.1182/blood.2020006252

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资金

  1. K07 award from the National Institutes of Health (NIH)/National Cancer Institute (NCI) [1K07CA211847]
  2. NIH/NCI Public Health Service [U24CA076518]
  3. NIH/National Heart, Lung and Blood Institute (NHLBI) [U24HL138660, OT3HL147741, R21HL140314, U01HL128568]
  4. NIH/Health Resources and Services Administration [HHSH250201700006C, SC1MC31881-01-00, HHSH250201700007C]
  5. Office of Naval Research [N00014-18-1-2850, N00014-18-1-2888, N00014-20-1-2705]
  6. NIH/NCI [P01CA111412, R01CA152108, R01CA215134, R01CA218285, R01CA231141]
  7. NIH/NHLBI [R01HL126589, R01HL129472, R01HL130388, R01HL131731]
  8. NIH/National Institute of Allergy and Infectious Diseases [R01AI128775, U01AI069197, U01AI126612]
  9. Biomedical Advanced Research and Development Authority
  10. Be theMatch Foundation
  11. Boston Children's Hospital
  12. Dana-Farber
  13. Japan Hematopoietic Cell Transplantation Data Center
  14. St Baldrick's Foundation
  15. National Marrow Donor Program
  16. Medical College of Wisconsin
  17. AbbVie
  18. Actinium Pharmaceuticals, Inc
  19. Adaptive Biotechnologies
  20. Adienne SA
  21. Allovir, Inc
  22. Amgen, Inc
  23. Anthem, Inc
  24. Astellas Pharma US
  25. AstraZeneca
  26. Atara Biotherapeutics, Inc
  27. bluebird bio, Inc
  28. Bristol Myers Squibb Co
  29. Celgene Corp
  30. Chimerix, Inc
  31. CSL Behring
  32. CytoSen Therapeutics, Inc
  33. Daiichi Sankyo Co, Ltd
  34. GamidaCell, Ltd
  35. Genzyme
  36. GlaxoSmithKline
  37. HistoGenetics, Inc
  38. Incyte Corp
  39. Janssen Biotech, Inc
  40. Janssen Pharmaceuticals, Inc
  41. Janssen/Johnson Johnson
  42. Jazz Pharmaceuticals, Inc
  43. Kiadis Pharma
  44. Kite Pharma
  45. Kyowa Kirin
  46. Legend Biotech
  47. Magenta Therapeutics
  48. Mallinckrodt, LLC
  49. Medac GmbH
  50. Merck Company, Inc
  51. Merck Sharp Dohme Corp
  52. Mesoblast
  53. Takeda Oncology Co
  54. Miltenyi Biotec, Inc
  55. Novartis Oncology
  56. Novartis Pharmaceuticals Corp
  57. Omeros Corp
  58. Oncoimmune, Inc
  59. Orca Biosystems, Inc
  60. Pfizer, Inc
  61. Phamacyclics, LLC
  62. Regeneron Pharmaceuticals, Inc
  63. REGiMMUNE Corp
  64. Sanofi Genzyme
  65. Seattle Genetics
  66. Sobi, Inc
  67. Takeda Oncology
  68. Takeda Pharma
  69. Terumo BCT
  70. Viracor Eurofins
  71. Xenikos BV
  72. Millennium

向作者/读者索取更多资源

This study aimed to investigate the impact of neighborhood poverty on outcomes of pediatric allogeneic HCT recipients, revealing that in malignant diseases, neighborhood poverty increased the risk of transplantation-related mortality but did not affect overall survival or other HCT outcomes; for nonmalignant diseases, neighborhood poverty had no association with HCT outcomes. Additionally, children with Medicaid insurance experienced worse overall survival and increased transplantation-related mortality in malignant diseases.
Social determinants of health, including poverty, contribute significantly to health outcomes in the United States; however, their impact on pediatric hematopoietic cell transplantation (HCT) outcomes is poorly understood. We aimed to identify the association between neighborhood poverty and HCT outcomes for pediatric allogeneic HCT recipients in the Center for International Blood and Marrow Transplant Research database. We assembled 2 pediatric cohorts undergoing first allogeneic HCT from 2006 to 2015 at age 518 years, including 2053 children with malignant disease and 1696 children with nonmalignant disease. Neighborhood poverty exposure was defined a priori per the US Census definition as living in a high-poverty ZIP code (>= 20% of persons below 100% federal poverty level) and used as the primary predictor in all analyses. Our primary outcome was overall survival (OS), defined as the time from HCT until death resulting from any cause. Secondary outcomes included relapse and transplantation-related mortality (TRM) in malignant disease, acute and chronic graft-versus-host disease, and infection in the first 100 days post-HCT. Among children undergoing transplantation for nonmalignant disease, neighborhood poverty was not associated with any HCT outcome. Among children undergoing transplantation for malignant disease, neighborhood poverty conferred an increased risk of TRM but was not associated with inferior OS or any other transplantation outcome. Among children with malignant disease, a key secondary finding was that children with Medicaid insurance experienced inferior OS and increased TRM compared with those with private insurance. These data suggest opportunities for future investigation of the effects of household-level poverty exposure on HCT outcomes in pediatric malignant disease to inform care delivery interventions.

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