Impact of Ethnicity and Socioeconomic Status on Outcome of Unrelated Donor (URD) Hematopoietic Cell Transplantation (HcT).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3064-3064 ◽  
Author(s):  
K. Scott Baker ◽  
Anna Hassebroek ◽  
Karen Ballen ◽  
Carolyn Bigelow ◽  
Haydar Frangoul ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
High Resolution ◽  
Ethnic Groups ◽  
Chronic Gvhd ◽  
Unrelated Donor ◽  
Median Income ◽  
Transplant Center ◽  
Increased Risk ◽  
Racial Ethnic ◽  
Zip Code

Abstract Prior studies suggest that success of HCT varies by race and ethnicity. This study examined whether disparate outcomes in URD-HCT are explained by socioeconomic status (SES), HLA disparity or other factors. Patients (n=6207) with acute or chronic leukemia or MDS, receiving myeloablative conditioning and URD HCT in the U.S., with available valid ZIP code, and reported to the CIBMTR between 1995–2004 were included. Patients were reported by the transplant center to be Caucasian (CC, n=5253), African American (AA, n=368), Asian/Pacific Islander (AP, n=141), or Hispanic (HS, n=445). We used 3 distinct HLA groupings with significantly different outcomes identified in another study to adjust for HLA disparity while accounting for best available resolution of typing. Well matched patients had no identified mismatches at HLA-A,B,C and DRB1 with low/intermediate or high resolution data available at HLA-A,B and high resolution DRB1. Partial matched patients had a single locus mismatch at any of the 4 loci and/or missing HLA-C data. Mismatched included any patient with 2 or more allele or antigen mismatches. Ethnic minorities were more likely than CC to have partially matched or mismatched donors. Patient income was estimated from reported residential ZIP code. The median follow-up of survivors ranged from 48 (AA and HS) to 66 months (CC). By Kaplan-Meier estimate, 1-year overall survival (OS) was 47% in CC, 32% in AA, 43% in AP, and 41% in HS (p<.001), and disease free survival (DFS) was 42% in CC, 28% in AA, 36% in AP, and 39% in HS (p<.001). These differences were sustained through 5 years post-HCT. Cox regression was used to examine the effect of study variables (age, performance status, income, co-morbidities, diagnosis, disease status, CMV status, stem cell source, HLA match, donor age and gender, year of HCT, conditioning regimen, cell dose, time from diagnosis to HCT, distance from patient ZIP code to transplant center) on the outcomes of interest between the 4 racial/ethnic groups. After adjusting for other significant factors, compared to CC, AA (but not AP or HS) were independently associated with worse OS (relative risk [RR] 1.46 (95% CI 1.28–1.66), P<.0001) and with worse DFS (RR 1.45 (1.27–1.64), P<.0001). The risk of treatment related mortality was higher in AA (RR 1.54, (1.33–1.79), P<.0001) and in HS (RR 1.23, (1.06–1.42), p=.005). HS had an increased risk of chronic GVHD (RR 1.24, (1.06–1.45), P=.008) compared to CC, otherwise there was no difference in the risk of acute or chronic GVHD among the racial groups. Race/ethnicity, median income and distance from transplant center were not associated with the risk of disease relapse. Greater distance to the transplant center (>175 miles) and higher median incomes (>$35,500) were associated with higher DFS (p=0.006, p=0.0002) and OS (p=0.001, p<0.0001) in all racial/ethnic groups. While this study is limited by the use of surrogate markers of SES and relatively small numbers of ethnic minority patients, the results suggest that the inferior outcomes after URD HCT detected primarily in AA patients are not fully explained by HLA disparity or SES indicators. Potential other mechanisms such as genetic polymorphisms that impact drug metabolism or the risk of TRM, as well as other pre- or post-transplant factors may be important.

scholarly journals Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

2021 ◽  
Author(s):  
Arnab K Ghosh ◽  
Orysya Soroka ◽  
Mark A Unruh ◽  
Martin Shapiro
Keyword(s):  
Socioeconomic Status ◽  
Length Of Stay ◽  
Median Income ◽  
Adverse Health Outcomes ◽  
Race Ethnicity ◽  
The Impact ◽  
Racial Ethnic ◽  
Fourth Quartile ◽  
Zip Code ◽  
Surgical Admission

Length of stay, a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES). Longer LOS is associated with adverse health outcomes. We assessed differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Using the 2009-2014 State Inpatient Datasets from three states, we examined trends in aALOS differences by race/ethnicity, and SES (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. For those discharged home, racial/ethnic and SES aALOS differences remained stable. Notably, for those discharged to non-home destinations, Black vs White, and low vs high SES aALOS differences increased significantly from 2009 to 2013, more sharply after Q3 2011, the introduction of the Affordable Care Act (ACA). Further research to understand the impact of the ACA on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

scholarly journals Improvements in Survival After Follicular Lymphoma by Race/Ethnicity and Socioeconomic Status: A Population-Based Study

2009 ◽  
Vol 27 (18) ◽  
pp. 3044-3051 ◽  
Author(s):  
Theresa H.M. Keegan ◽  
Laura A. McClure ◽  
James M. Foran ◽  
Christina A. Clarke
Keyword(s):  
Socioeconomic Status ◽  
Follicular Lymphoma ◽  
Ethnic Groups ◽  
Large Population ◽  
Population Based ◽  
Risk Of Death ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Neighborhood Ses

Purpose A recent report suggested improvements in survival after follicular lymphoma (FL), but not for all racial/ethnic groups. To better understand the reasons for these FL survival differences, we examined the joint influences of diagnostic period, race/ethnicity, and neighborhood socioeconomic status (SES) on survival in a large population-based case series. Methods All patients (n = 15,937) diagnosed with FL between 1988 and 2005 in California were observed for vital status through November 2007. Overall and FL-specific survival were analyzed with Kaplan-Meier and Cox proportional hazards regression. Neighborhood SES was assigned from United States Census data using residence at diagnosis. Results Overall and FL-specific survival improved 22% and 37%, respectively, from 1988 to 1997 to 1998 to 2005, and were observed in all racial/ethnic groups. Asian/Pacific Islanders had better survival than non-Hispanic white, Hispanic, and black patients who had similar outcomes. Lower neighborhood SES was associated with worse survival in patients across all stages of disease (P for trend < .01). Patients with the lowest SES quintile had a 49% increased risk of death from all causes (hazard ratio [HR] = 1.49, 95% CI, 1.30 to 1.72) and 31% increased risk of death from FL (HR = 1.31; 95% CI, 1.06 to 1.60) than patients with the highest SES. Conclusion Evolving therapies have likely led to improvements in survival after FL. Although improvements have occurred within all racial/ethnic groups, lower neighborhood SES was significantly associated with substantially poorer survival.

scholarly journals Race, Adolescent Socioeconomic Status, and Lifetime Non-Medical Use of Prescription Painkillers: Evidence from the National Longitudinal Study of Adolescent to Adult Health

2021 ◽  
Vol 18 (23) ◽  
pp. 12289
Author(s):  
Amy Ehntholt ◽  
Roman Pabayo ◽  
Lisa Berkman ◽  
Ichiro Kawachi
Keyword(s):  
Socioeconomic Status ◽  
Longitudinal Study ◽  
Ethnic Differences ◽  
Early Life ◽  
Family Income ◽  
Opioid Overdose ◽  
Adult Health ◽  
National Longitudinal Study ◽  
Increased Risk ◽  
Racial Ethnic

The misuse of prescription painkillers is a major contributor to the ongoing drug overdose epidemic. This study investigated variability in non-medical use of prescription painkillers (NMUPP) by race and early-life socioeconomic status (SES) in a sample now at increased risk for opioid overdose. Data from two waves of the National Longitudinal Study of Adolescent to Adult Health (n = 11,602) were used to calculate prevalence of reported NMUPP by Wave 4 (2008; mean age 28), and to assess variation by race and by equivalized household family income at Wave 1 (1994/5). Predicted values for prevalence of NMUPP were modelled, adjusting for age, sex, parental education, and region. Race and SES in adolescence were associated with later reported NMUPP. A gradient was seen in prevalence by SES (adjusted: family income quartile 1 = 13.3%; quartile 2 = 13.8%; quartile 3 = 14.8%; quartile 4 = 16.0%; trend p-value = 0.007). Prevalence was higher among males. Racial/ethnic differences in prevalence were seen (non-Hispanic white (NHW) = 18.5%; non-Hispanic black (NHB) = 5.8%; Hispanic = 10.5%; Other = 10.0%). SES differences were less pronounced upon stratification, with trend tests significant only among females (p = 0.004), and marginally significant among Hispanic males (p = 0.06). Early-life SES was associated with reported lifetime NMUPP: the higher the family income in adolescence, the greater the likelihood of NMUPP by young adulthood. Variations in NMUPP by income paled in comparison with racial/ethnic differences. Results point to a possible long-enduring association between SES and NMUPP, and a need to examine underlying mechanisms.

Alemtuzumab (Campath 1-H) Exposure Correlates with Risk of Chronic Graft vs Host Disease and CMV Viremia after Allogeneic Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1818-1818
Author(s):  
Justin P. Kline ◽  
Rajiv Swamy ◽  
Dezheng Huo ◽  
Laura Michaelis ◽  
Richard A. Larson ◽  
...  
Keyword(s):  
At Risk ◽  
Half Life ◽  
Immune Reconstitution ◽  
Chronic Gvhd ◽  
Absolute Lymphocyte Count ◽  
Enzyme Linked Immunosorbent Assay ◽  
Unrelated Donor ◽  
Increased Risk ◽  
Cmv Reactivation

Abstract Conditioning regimens using in vivo alemtuzumab (Campath-1H, humanized anti-CD52) are characterized by low rates of acute and chronic GVHD, but may also result in delayed immune reconstitution. Optimization of such regimens will depend on an understanding of the relation between alemtuzumab exposure, immune reconstitution and GVHD. We have conducted a prospective study of fludarabine 30 mg/m2/d x 5 days, melphalan 140 mg/m2 x 1 day and alemtuzumab 20 mg/d x 5 days as conditioning for related and unrelated allografts. Using an enzyme-linked immunosorbent assay (ELISA), we determined serum free and total Campath levels in 46 patients with hematologic malignancies (45) or sickle cell disease (1) on day 0, day 7, day 14, day 28, day 50, day 75, day 100, day 150 and at one year after transplant (HSCT). 26 (57%) had a matched sibling donor, 16 (35%) a matched unrelated donor (MUD) and 4 (9%) a mismatched related or unrelated donor. 44 pts engrafted and are included in the analysis. Median follow up for survivors was 2.8 years. Grade II–IV aGVHD occurred in 8 pts after a median of 42 days (range 22 to 60). Eight pts developed cGVHD after a median of 107 days (range 89–140). 15/41 (37%) at risk pts developed CMV reactivation. The half-life of free alemtuzumab (fA) was 26 days after HSCT with wide interpatient variation in fA pharmacokinetics (e.g. Coefficient of variation was 138% on day 0). On day 0, 1 patient had an undetectable level of fA. By day 28, 50, and 100, there were 6 (14.6%), 12 (35.3%), and 13 (52%) pts with undetectable fA, respectively. Figure 1 shows the fitted means and 95% confidence intervals of fA over time. Using log-rank and Cox proportional hazard models, there was no association between fA on day 0, day 28, or the last available fA, and development of acute GVHD. However, pts with higher average free and total Campath levels in the first month had a lower risk of developing cGVHD (p=0.02). The median fA concentration in the first month for pts with cGVHD was 0.32 (inter-quarter range IQR: 0.22–0.41), as compared with 0.97 (IQR: 0.23–3.31) in those without cGVHD. No significant association between absolute lymphocyte count and fA concentration was found after adjusting for time (p=0.28). Finally, among pts at risk, a higher fA concentration on day 0 (p=0.002), and in the first month (p=0.003) was significantly associated with CMV viremia. In summary, the estimated half-life of serum fA is 26 days after HSCT, but with considerable interpatient variability. Higher concentrations of fA were associated with a decreased incidence of cGVHD, but an increased risk of CMV reactivation. In contrast to a previous preliminary analysis, no association existed between fA and lymphocyte reconstitution. Variation in alemtuzumab pharmacokinetics may predict important clinical outcomes, such as cGVHD and CMV reactivation. Future studies are warranted to determine an optimal alemtuzumab exposure that hastens immune reconstitution while minimizing chronic GVHD. Fig 1. Fitted Mean Free Campath and 95% CI Fig 1. Fitted Mean Free Campath and 95% CI

Delayed Cytomegalovirus (cmv) Infection Following Hematopoietic Cell Transplantation (HCT): City of Hope (COH) Experience.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1155-1155
Author(s):  
Alexandra Schaible ◽  
Allison Mays ◽  
Can-Lan Sun ◽  
Liton Francisco ◽  
Lennie Wong ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Chronic Gvhd ◽  
First Year ◽  
Unrelated Donor ◽  
Cmv Infection ◽  
Allogeneic Hct ◽  
Increased Risk ◽  
Related Donor ◽  
Autologous Hct ◽  
One Year

Abstract Patients undergoing HCT are at an increased risk of developing primary and/or reactivated CMV infection, although the magnitude of risk of CMV disease has decreased with the widespread use of preemptive ganciclovir. Most episodes of reactivation occur within the first year post-HCT and are associated with risk factors such as CMV serostatus of donor and recipient, development of acute graft vs. host disease (GVHD): and the immunosuppressive therapy used for its management. Because of prolonged periods of immunosuppression post-HCT, patients may be at risk for delayed CMV infection one or more years after HCT. However, the magnitude of risk of delayed CMV infection and characteristics of those at increased risk has not been described. Given the high morbidity and mortality associated with post-HCT CMV infection, identifying patients at high risk of delayed CMV could be useful for effective management. This report includes 2700 consecutive patients who survived more than one year after undergoing HCT at COH between 1976 and 2003; these included 1404 autologous HCT recipients and 1296 allogeneic HCT recipients (1043 related donor; 253 unrelated donor recipients). Median age at HCT was 38 years (range, 0.6 to 79 years) and 59% of the cohort was males. Median follow-up time from HCT until delayed CMV infection/disease, death, or end of study period (12/31/2006), whichever occurred first, was 4.3 years (range:1–26.6 years). Medical records from COH and/or outside facilities were the main source of data for CMV occurrences. In total, 33 patients (1%) developed delayed CMV infection after surviving at least one year post-HCT (1 autologous and 32 allogeneic [20 related donor and 12 unrelated donor HCT]) developed a total of 40 episodes of delayed CMV that included pneumonia (n=16), gastrointestinal disease (n=8), retinitis (n=2), hepatitis (n=1), concurrent pneumonia and hepatitis (n=1), and asymptomatic reactivation (n=12). The overall cumulative incidence of delayed CMV infection was 1.3% (95% Confidence Interval [CI], 0.9–1.8%) at 5 years from HCT. For autologous HCT recipients, the incidence was 0.07% at 1 year based on 1 event. Among allogeneic HCT recipients, the cumulative incidence at 5 years post-HCT was 2.1% [95%CI, 1.2–3.0%] for related donor HCT recipients; and 5.0% [95%CI, 2.2–7.7%] for unrelated donor HCT recipients. Among allogeneic HCT recipients, the risk factors for the development of delayed CMV infection included unrelated donor HCT (hazard ratio [HR] = 2.5, 95% CI, 1.1–5.7) and CMV seropositive status of the recipient (HR=7.7, 95% CI 1.0–57.0) (Figure). Interestingly, donor CMV status was not associated with increased risk of delayed CMV. All 32 allogeneic HCT recipients experienced chronic GVHD, with prolonged exposures to corticosteroids (median=494 days), and cyclosporine (median=380 days). Thirty patients with delayed CMV infection (94% of the allogeneic HCT recipients with delayed CMV) were receiving immunosuppressive therapy for management of chronic GVHD at onset of delayed CMV. A total of eight patients with delayed CMV did not have a history of CMV infection in the first year, and were characterized by the following clinical and demographic features: 6 (75%) were male; median age at HCT was 35 years; one was an autologous HCT recipient, who relapsed 10 months post-HCT for non-Hodgkin lymphoma, received further chemotherapy and radiation, including Rituximab and then developed late CMV, just over one year post-HCT. The seven allogeneic HCT recipients had chronic GVHD, and were CMV serostatus positive prior to HCT, with 4 also having CMV seropositive donors. Of the 33 patients with delayed CMV in this study, 26 expired; median survival after the development of delayed CMV was 46 days. This study describes the magnitude of risk of delayed CMV infection in autologous and allogeneic HCT recipients and identifies at risk patients as those who are seropositive for CMV, undergoing unrelated HCT, and those with prolonged exposures to immunosuppressive therapy for cGVHD (Figure), suggesting the need for a close surveillance of these patients at high risk. Figure Figure

Allogeneic Stem Cell Transplantation (allo-SCT) for Secondary Acute Myeloid Leukemia (AML) Following Breast Carcinoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3305-3305
Author(s):  
Sameh Ayari ◽  
Mohamad Mohty ◽  
Karin Bilger ◽  
Gaelle Guillerm ◽  
Denis Guyotat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Breast Carcinoma ◽  
Myeloid Leukemia ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Unrelated Donor ◽  
Increased Risk ◽  
Acute Myeloid

Abstract Abstract 3305 Poster Board III-193 Patients with breast carcinoma who received Radio and/or chemotherapy, have an increased risk for developing therapy-related myelodysplastic syndromes/acute myeloid leukemia (1-5%). Such secondary AMLs have often poor prognosis when treated with conventional chemotherapy. This retrospective series assessed the outcome of 29 female patients who were reported to the Societe Francaise de Greffe de Moelle et de Therapie Cellulaire Registry, and who were treated with allo-SCT for secondary MDS/AML developing after initial therapy for breast cancer. The median age of patients at time of breast cancer treatment was 51 (range, 31-62) years. The median age at time of allo-SCT was 53 (range 31-63) years. Diagnosis included 21 AML and 8 MDS. Cytogenetics: four patients had CBF abnormalities, 10 had 11q23 abnormalities, 5 had an intermediate caryotype and 3 had unfavourable one. At time of allo-SCT, 21 patients were in complete remission (CR), while 8 had a refractory/relapsed disease. PBSCs were used as stem cell source in 18 patients, while 9 patients received classical bone marrow and one patient received an unrelated umbilical cord blood. Patients received a median of 5.2 ×10e6/Kg CD34+ cells. A matched related donor was used in 23 cases (82%) and an unrelated donor in 5 cases (18%). Conditioning regimen was myeloablative (Cy-TBI or Bu-Cy) in 7 cases (24%) and reduced-intensity in 22 cases (76%). Twenty four patients engrafted with a median time of 18 (range, 9-32) days for ANC>500/μL. Seven (24%) patients experienced grade 2-4 acute GVHD. Also, 7 patients (24%) experienced chronic GVHD (5 extensive and 2 limited). With a median follow-up of 24 (range, 3-129) months, 16 patients (55%) were still alive. Disease progression accounted for 6 deaths while transplant related causes (infection n=4, GVHD n=1, MOF n=1, cardiac failure n=1) occurred in 7 cases. The Kaplan-Meier estimates of overall and disease-free survival at 2 years were at 54 and 38% respectively. These results highlight the poor outcome of secondary leukemia occurring after therapy for breast cancer, even with the use of allo-SCT. Innovative maintenance approaches such as early use of hypomethylating or immunomodulatory agents after allo-SCT aiming to decrease the relapse are warranted. Disclosures No relevant conflicts of interest to declare.

Pancreatic cancer: Do disparities in mortality rates exist with respect to socioeconomic status?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19007-e19007
Author(s):  
Richard Stephen Sheppard ◽  
Adewumi Adekunle ◽  
Stefani Beale ◽  
Janet Joseph ◽  
Gerald Fletcher ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Socioeconomic Status ◽  
Mortality Rates ◽  
Ordinary Least Squares ◽  
Mortality Data ◽  
P Value ◽  
Malignant Neoplasms ◽  
Median Income ◽  
Survival Times ◽  
Zip Code

e19007 Background: Pancreatic cancer continues to have one of the highest mortality rates among major cancer diagnoses with rates greater than 90 percent for all stages and with five year survival rates below 10 percent. With access to treatment modalities such as chemo-radiation, staged surgical interventions and targeted therapies, survival times have increased but due to the costs of these procedures, they may not be accessible to all members of society. Recent studies have shown that lower socioeconomic status is associated with higher mortality rates and lower survival times. With this study we aim to investigate if disparities exist among socioeconomic classes, based on zip code location, in a major multi-ethnic metropolitan city using census data. Methods: Malignant neoplasm mortality data at the ZIP code level was gathered from the New York City Department of Health Vital Statistics Mortality Data from years 2009-2011. NYC population data was gathered from the U.S. Census Bureau 2010 decennial census. We used ordinary least squares regression to assess the independent association between neighborhood median income and neighborhood mortality from malignant neoplasms arising from the pancreas. Results: In 2009-2011, 2,527 deaths from malignant neoplasms arising from the pancreas were recorded across NYC. There is no statistically significant correlation between neighborhood median income and age-adjusted mortality from malignant neoplasms arising from the pancreas for males and for females. For males, there was an R-squared of 0.001721 ( P-value > 0.05). For females, there was an adjusted adjusted R-squared of 9.818e-05 ( P-value > 0.05). Conclusions: Neighborhood median income is not associated with an increase in mortality rate with respect to neoplasms arising from the pancreas.

scholarly journals Usage of a Digital Health Workplace Intervention Based on Socioeconomic Environment and Race: Retrospective Secondary Cross-Sectional Study (Preprint)

2017 ◽  
Author(s):  
Conor Senecal ◽  
R Jay Widmer ◽  
Kent Bailey ◽  
Lilach O Lerman ◽  
Amir Lerman
Keyword(s):  
Socioeconomic Status ◽  
High Risk ◽  
Digital Health ◽  
Demographic Data ◽  
Health Intervention ◽  
Median Income ◽  
Cross Sectional ◽  
Socioeconomic Environment ◽  
One Year ◽  
Zip Code

BACKGROUND Digital health tools have been associated with improvement of cardiovascular disease (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes is not well known. OBJECTIVE To identify the effect of socioeconomic environment on usage of a digital health intervention. METHODS A retrospective secondary cross-sectional analysis of a workplace digital health tool use, in association with a change in intermediate markers of CVD, was undertaken over the course of one year in 26,188 participants in a work health program across 81 organizations in 42 American states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and hemoglobin A1c. Follow-up data was then obtained in 90-day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. Digital health intervention usage was analyzed based on socioeconomic status as well as age, gender, and race. RESULTS The cohort was found to represent a wide sample of socioeconomic environments from a median income of US $11,000 to $171,000. As a whole, doubling of income was associated with 7.6% increase in log-in frequency. However, there were marked differences between races. Black participants showed a 40.5% increase and Hispanic participants showed a 57.8% increase in use with a doubling of income, compared to 3% for Caucasian participants. CONCLUSIONS The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and digital health intervention usage for Caucasian users. However, a strong relationship is present for black and Hispanic users. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for CVD. This finding identifies a need for digital health apps that are effective in these high-risk groups.

Racial/Ethnic Differences in Illicit Substance Use: A Temporal-Ordered Test of General Strain Theory

2020 ◽  
Vol 50 (2) ◽  
pp. 209-230 ◽  
Author(s):  
William Ash-Houchen ◽  
Celia C. Lo
Keyword(s):  
Substance Use ◽  
Ethnic Groups ◽  
General Strain Theory ◽  
Strain Theory ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Increased Risk ◽  
General Strain ◽  
Illicit Use ◽  
Racial Ethnic

This longitudinal study applied general strain theory to elaborate specific stressful events’ lagged effects on risk of illicit substance use among non-Hispanic White, non-Hispanic Black, and Hispanic adolescents, and relatedly evaluated the moderating role of race/ethnicity in explaining illicit use. Data were drawn from five waves representing 9 years (2002–2010) of the 1997 National Longitudinal Survey of Youth (NLSY), totaling 16,868 person-waves, and we engaged temporal ordering and generalized estimating equations (GEE) for panel data in STATA for data analysis. Results showed specific events affected risk of illicit substance use differentially across racial/ethnic groups. Strains commonly encountered in disorganized spaces affected non-Hispanic White’s risk. Measured strains did not affect non-Hispanic Black respondents and findings for Hispanic respondents point to the family as a possible strain. Results indicated legal drug use and depression increased risk of illicit use greatly. Race/ethnicity’s role in illicit use’s associations with several variables illustrates differential implications for racial/ethnic groups in policy and preventive interventions.

A Comparison of Stem Cell Source in Recipients of T-Cell Depleted Myeloablative Transplants for Leukaemia: No Difference in Mortality Using BM or PBSC.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 46-46
Author(s):  
B.E. Shaw ◽  
Nigel H. Russell ◽  
A. Pagliuca ◽  
J. Apperley ◽  
G. Cook ◽  
...  
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Unrelated Donor ◽  
Stem Cell Source ◽  
Increased Risk ◽  
Significant Difference ◽  
Cell Source ◽  
The Impact

Abstract The use of GSCF-mobilised Peripheral Blood Stem Cells (PBSC) for unrelated donor (UD) transplantation has increased dramatically since 2000. The association of PBSC with more rapid engraftment and with an increase in chronic Graft versus Host Disease (GvHD), compared to bone marrow (BM) has been reported in a number of studies. More recently the use of PBSC has been associated with an increase in transplant related mortality (TRM) and decrease in survival (OS) in T-cell replete transplants. We sought to analyse the impact of PBSC compared to BM in a cohort of UD transplant recipients, where T-cell depleting agents (in-vivo campath in >90%) were included in the transplant conditioning. The study included 145 patients transplanted between January 2000 and March 2006: CML- 35 in 1CP; acute leukaemia (AML in 61, ALL in 49)-110 in CR1 or 2. All had myeloablative conditioning regimens and received grafts with 9–10/10 matched HLA alleles. 86 patients received BM and 59 PBSC. There were no associations between the stem cell source and any transplant variable (including disease and stage). There was a trend to an increased use of PBSC in patients with a single antigen mismatch (p=0.052). All evaluable patients achieved neutrophil engraftment, with a significantly faster time to engraft in recipients of PBSC compared to BM (16 vs 20 days; p=0.0003). The incidence of acute GvHD was 46% (grade I in 50%, II in 41%, III in 8%, IV in 2%). This was significantly higher in recipients of PBSC (60%) compared to BM (36%; p=0.006), however there was no increase in either II/IV (p=0.69) or III/IV (p=0.18) disease in PBSC recipients. In univariate analysis, the presence of a single HLA mismatch (p=0.026) was the only other variable to be associated with an increase in acute GvHD. In a logistic regression model including both these variables, the use of PBSC remained significantly associated with an increase in aGvHD (OR=2.3; 95% CI 1.1,4.7;p=0.020). The TRM was 14%, 27% and 39% at 100 days, 1 and 5 years respectively. At none of these time points was the stem cell source associated with a significant difference in TRM. The 5-year incidence of chronic GvHD was 58% (BM 55%, PBSC 60%; NS), extensive disease in one third, and of relapse was 61% (BM 60%, PBSC 62%; NS). The 5-years OS was 41% with a median follow-up of 3.4 years (0.5–7.1). This was 44% using PBSC and 40% using BM (NS). In conclusion, although we observed an increase in acute GVHD with PBSC this was only of grade 1 disease. We found no association between the use of PBSC and an increased risk of chronic GVHD or of a worse transplant outcome, when compared to BM, in recipients of T-cell depleted myeloablative transplants for leukaemia.

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