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Race and socioeconomic status in pediatric allogeneic hematopoietic cell transplantation for nonmalignant conditions
Author(s) -
Harney Sarah M.,
Kahn Justine M.,
Jin Zhezhen,
Wong Priscilla,
McKetta Sarah,
Satwani Prakash
Publication year - 2020
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28367
Subject(s) - medicine , socioeconomic status , transplantation , hematopoietic stem cell transplantation , ethnic group , race (biology) , population , gerontology , demography , pediatrics , environmental health , botany , sociology , anthropology , biology
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.