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

Kira Bona*, Ruta Brazauskas, Naya He, Leslie Lehmann, Hisham Abdel-Azim, Ibrahim A. Ahmed, A. Samer Al-Homsi, Mahmoud Aljurf, Staci D. Arnold, Sherif M. Badawy, Minoo Battiwalla, Sara Beattie, Neel S. Bhatt, Jignesh Dalal, Christopher E. Dandoy, Miguel Angel Diaz, Haydar A. Frangoul, César O. Freytes, Siddhartha Ganguly, Biju GeorgeDavid Gomez-Almaguer, Theresa Hahn, Rammurti T. Kamble, Jennifer M. Knight, C. Fred LeMaistre, Jason Law, Hillard M. Lazarus, Navneet S. Majhail, Richard F. Olsson, Jaime Preussler, Bipin N. Savani, Raquel Schears, Sachiko Seo, Akshay Sharma, Alok Srivastava, Amir Steinberg, David Szwajcer, Baldeep Wirk, Ayami Yoshimi, Nandita Khera, William A. Wood, Shahrukh Hashmi, Christine N. Duncan, Wael Saber

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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 ≤18 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.

Original languageEnglish (US)
Pages (from-to)556-568
Number of pages13
JournalBlood
Volume137
Issue number4
DOIs
StatePublished - Jan 28 2021

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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