Community health status and outcomes after allogeneic hematopoietic cell transplantation in the United States

Autor: Alois Gratwohl, Jason Law, David Szwajcer, Jean A. Yared, Bronwen E. Shaw, Ruta Brazauskas, Amer Beitinjaneh, Matthew L. Ulrickson, Hisham Abdel-Azim, Sara Beattie, Navneet S. Majhail, Shahrukh K. Hashmi, J. Douglas Rizzo, Wael Saber, Neel S. Bhatt, William A. Wood, Charles F. LeMaistre, Stephanie J. Lee, Bipin N. Savani, Sherif M. Badawy, Stefan O. Ciurea, Richard F. Olsson, David A. Rizzieri, Hasan Hashem, Sachiko Seo, Sanghee Hong, Jan Cerny, Akshay Sharma, Kyle Hebert, Hélène Schoemans, Hillard M. Lazarus, Ayami Yoshimi, Rammurti T. Kamble, Siddhartha Ganguly, Nosha Farhadfar, Theresa Hahn, Miguel Angel Diaz, Nandita Khera, Mahmoud Aljurf, Usama Gergis
Rok vydání: 2020
Předmět:
Male
Cancer Research
0302 clinical medicine
Risk Factors
80 and over
Medicine
030212 general & internal medicine
Cancer
Aged
80 and over
community health
Framingham Risk Score
Hazard ratio
Hematopoietic Stem Cell Transplantation
Hematology
Middle Aged
allogeneic transplant
Treatment Outcome
Local
Oncology
Hematologic Neoplasms
030220 oncology & carcinogenesis
Community health
Public Health and Health Services
Female
Public Health
Homologous
Adult
medicine.medical_specialty
Adolescent
Oncology and Carcinogenesis
survival
Community Health Planning
Article
Young Adult
03 medical and health sciences
Clinical Research
Internal medicine
Transplantation
Homologous
Humans
Nonrelapse mortality
hematopoietic cell transplantation
Oncology & Carcinogenesis
Aged
Transplantation
Hematopoietic cell
business.industry
Prevention
United States
Neoplasm Recurrence
Good Health and Well Being
Increased risk
Bone transplantation
Neoplasm Recurrence
Local
business
Zdroj: Cancer
Cancer, vol 127, iss 4
ISSN: 1097-0142
0008-543X
DOI: 10.1002/cncr.33232
Popis: Background The association of community factors and outcomes after hematopoietic cell transplantation (HCT) has not been comprehensively described. Using the County Health Rankings and Roadmaps (CHRR) and the Center for International Blood and Marrow Transplant Research (CIBMTR), this study evaluated the impact of community health status on allogeneic HCT outcomes. Methods This study included 18,544 adult allogeneic HCT recipients reported to the CIBMTR by 170 US centers in 2014-2016. Sociodemographic, environmental, and community indicators were derived from the CHRR, an aggregate community risk score was created, and scores were assigned to each patient (patient community risk score [PCS]) and transplant center (center community risk score [CCS]). Higher scores indicated less healthy communities. The impact of PCS and CCS on patient outcomes after allogeneic HCT was studied. Results The median age was 55 years (range, 18-83 years). The median PCS was -0.21 (range, -1.37 to 2.10; standard deviation [SD], 0.42), and the median CCS was -0.13 (range, -1.04 to 0.96; SD, 0.40). In multivariable analyses, a higher PCS was associated with inferior survival (hazard ratio [HR] per 1 SD increase, 1.04; 99% CI, 1.00-1.08; P = .0089). Among hematologic malignancies, a tendency toward inferior survival was observed with a higher PCS (HR, 1.04; 99% CI, 1.00-1.08; P = .0102); a higher PCS was associated with higher nonrelapse mortality (NRM; HR, 1.08; 99% CI, 1.02-1.15; P = .0004). CCS was not significantly associated with survival, relapse, or NRM. Conclusions Patients residing in counties with a worse community health status have inferior survival as a result of an increased risk of NRM after allogeneic HCT. There was no association between the community health status of the transplant center location and allogeneic HCT outcomes.
Databáze: OpenAIRE
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