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

Abstract：

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.

journal_name

Cancer

journal_title

Cancer

authors

Hong S,Brazauskas R,Hebert KM,Ganguly S,Abdel-Azim H,Diaz MA,Beattie S,Ciurea SO,Szwajcer D,Badawy SM,Gratwohl AA,LeMaistre C,Aljurf MDSM,Olsson RF,Bhatt NS,Farhadfar N,Yared JA,Yoshimi A,Seo S,Gergis U,Beitinjane

doi

10.1002/cncr.33232

subject

Has Abstract

pub_date

2021-02-15 00:00:00

pages

609-618

issue

eissn

0008-543X

issn

1097-0142

journal_volume

127

pub_type

杂志文章

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