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.

Impact of Socioeconomic Status & Race/Ethnicity On Survival in Diffuse Large B-Cell Lymphoma (DLBCL): A Population-Based Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1954-1954
Author(s):  
James M. Foran ◽  
Laura A. McClure ◽  
Christina A. Clarke ◽  
Theresa H. M. Keegan
Keyword(s):  
Socioeconomic Status ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Block Group ◽  
Census Block ◽  
Census Block Group ◽  
Risk Of Death ◽  
Race Ethnicity ◽  
The Impact ◽  
Neighborhood Ses

Abstract Abstract 1954 Poster Board I-977 Introduction: Despite advances in treatment and a well-characterized prognostic index, significant heterogeneity remains in DLBCL survival. Preliminary data suggest a potential survival disparity based on race/ethnicity or socioeconomic status (SES). To evaluate the impact of these and other variables on survival we performed an analysis in the ethnically diverse population-based California Cancer Registry (CCR). We utilized Neighborhood SES, an index of 7 census measures of education, income, occupation & cost of living, based on the residential census-block group at diagnosis. Each census-block group comprises ∼1500 residents. Neighborhood SES has been shown to be significantly associated with survival after Follicular Lymphoma (JCO 27:3044, 2009). Methods: All pts with DLBCL (ICD-O-3 codes 9680 & 9684) diagnosed from Jan 1988 to Dec 2007 and reported to CCR were included in the analysis, including n=16,892 diagnosed from 1988-2000, and n=11,916 from 2001-2007 (total study pop'n =28,808). HIV/AIDS pts were excluded, as were n=63 with Mediastinal LBCL & n=10 with primary effusion lymphoma. The mean age was 63 yrs, and the cohort was 53% male. Between time periods, there was a relative increase in Hispanic pts [15.4% (1988-2000) to 20.8% (2001-2007), p<0.001], and a 4% increase in advanced stage from 42% (1988-2000) to 46% (2001-2007) (p<0.001). Neighborhood SES was stratified into quintiles from lowest (SES-1) to highest (SES-5), the pt distribution was: SES-1, 14%; SES-2, 18%; SES-3, 21%; SES-4, 23%; and SES-5, 24%. To evaluate the impact of prognostic factors (particularly diagnosis period, SES, and race/ethnicity) on overall survival (OS) & disease-specific survival (DSS) we used Cox proportional hazards regression to calculate hazard ratios (HR) for death with 95% CI's. Multivariate regression models included variables significant at p<0.15 in univariate models or with a priori hypotheses for inclusion. Results are presented by stage at diagnosis [Localized/Regional (LocReg) vs. Advanced (ADV)]. Results: There was a significant improvement in OS in patients diagnosed after 2001 for both LocReg (HR 0.87, 95%CI 0.82-0.91, p<0.001) and ADV stage (HR 0.69, 95%CI 0.66-0.72, p<0.001), which correlates with the introduction of rituximab into therapy for DLBCL. As expected, age >60 years was associated with a significantly worse OS for LocReg (HR 3.06, 95%CI 2.90-3.24) and ADV stage (2.02, 95%CI 1.93-2.12). Females also had significantly better OS compared with males (Loc-Reg - HR 0.90, 95%CI 0.86-0.94; ADV - HR 0.89, 95%CI 0.85-0.93). There was no significant impact of race/ethnicity on survival with the exception of non-Hispanic Asian/Pacific Islanders (NH A/PI) with ADV stage, for whom OS was significantly inferior compared with whites (HR 1.18, 95%CI 1.09-1.27, p<0.001). Compared with the highest quintile (SES-5), there was a significant effect of lower neighborhood SES on OS and DSS (see Table). Conclusion: There has been a significant improvement in survival after DLBCL since 2001, but patients in the lowest SES-1 quintile have a 34% higher risk of death from any cause and 20% higher risk for death from lymphoma than those in the highest SES-5. In this model, race/ethnicity did not have a significant impact on survival with the exception of NH A/PI with ADV stage. Studies to understand and address these socioeconomic disparities are urgently required in order to extend the improvements in DLBCL survival more effectively. Disclosures: Foran: Genentech: Honoraria, Research Funding.

6074Cardiorespiratory fitness, socioeconomic status and mortality in middle-aged men: a population-based prospective cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Y Jae ◽  
S Kurl ◽  
B A Franklin ◽  
J Choo ◽  
H J Kim ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Heart Disease ◽  
Density Lipoprotein ◽  
Population Based ◽  
Lipoprotein Cholesterol ◽  
Low Ses ◽  
Risk Of Death ◽  
Increased Risk ◽  
Material Standard Of Living ◽  
Cvd Mortality

Abstract Background Although both low socioeconomic status (SES) and poor cardiorespiratory fitness (CRF) are associated with increased chronic disease and a heightened risk of death, it remains unclear whether moderate-to-high levels of CRF confer survival benefits in low SES populations. Purpose The present study evaluated the hypothesis that SES and CRF predict all-cause mortality (ACM), cardiovascular disease (CVD) mortality and sudden cardiac death (SCD), and that moderate-to-high levels of CRF may attenuate the associations between low SES and adverse cardiovascular outcomes. Methods This prospective study was based on a population-based sample of 2,368 men aged 42 to 61 years, who were followed in the Kuopio Ischemic Heart Disease cohort. CRF was directly measured by peak oxygen uptake (VO2peak) during progressive exercise testing to volitional fatigue. SES was characterized using self-reported questionnaires via combined measures of income, education, occupation, occupational prestige, material standard of living, and housing conditions. CRF and SES were divided into tertiles, and 4 combined groups (Fit-high SES, Fit-low SES, Unfit-high SES, and Unfit-low SES) based on the median values of CRF and SES. Results During a 25 year median follow-up (interquartile ranges: 18–27 years), 1116 ACM, 512 CVD mortality and 221 SCD events occurred. After adjusting for potential confounders (age, smoking, alcohol, body mass index, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, glucose, diabetes, hypertensive medication, family history of coronary heart disease, and physical activity), the lowest levels of SES were at significantly increased risk for ACM (hazard ratio (HR) 1.49, 95% Confidence Interval (CI): 1.30–1.71), CVD mortality (HR 1.38, 1.13–1.69) and SCD (HR 1.34, 0.97–1.84). In contrast, higher levels of CRF were associated with lower risks of ACM (HR 0.56, 0.46–0.67), CVD mortality (HR 0.53, 0.40–0.71) and SCD (HR 0.53, 0.34–0.83). In combined associations of SES and CRF with mortality, unfit-low SES had significantly higher risks of ACM (HR 2.12, 1.75–2.57), CVD mortality (HR 2.20, 1.64–2.94) and SCD (HR 2.95, 1.79–4.86), but fit-low SES was not associated with a heightened risk of cardiovascular mortality or SCD (CVD mortality, 1.03, 0.73–1.46; SCD, 1.54, 0.87–2.72) as compared with their fit-high SES counterparts (reference). Conclusion Our findings indicate that both SES and CRF are independently associated with the risk of death; however, moderate-to-high levels of CRF appear to attenuate the risk of CVD mortality and SCD in low SES men. These unique data have important implications for public health interventions designed to enhance survival in underserved population cohorts.

scholarly journals SURVIVAL ADVANTAGE OF APOE2

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S621-S621
Author(s):  
Sudha Seshadri
Keyword(s):  
Lower Risk ◽  
Large Population ◽  
Population Based ◽  
European Ancestry ◽  
Aggregated Data ◽  
Risk Of Death ◽  
Apoe Ε4 ◽  
Increased Risk ◽  
Ε4 Allele

Abstract Apolipoprotein E is a glycoprotein mediator and regulator of lipid transport and uptake. The APOE-ε4 allele has been associated with higher risk of Alzheimer’s disease and of mortality, but the effect of the less prevalent APOE-ε2 on survival remains elusive. We aggregated data of 38,537 individuals of European ancestry (mean age 65.5 years; 55.6% women) from six large population-based cohorts to determine the association of APOE-ε2, with survival in the general population. During a mean follow-up of 11.7 years, 17,021 individuals died. Compared with homozygous APOE-ε3 carriers, APOE-ε2 carriers were at lower risk of death (hazard ratio,95% confidence interval: 0.94,0.90-0.99; P=1.1*10-2), whereas APOE-ε4 carriers were at increased risk (HR 1.17,1.12-1.21; P=2.8*10-16). Risk was lowest for homozygous APOE-ε2 (HR 0.89,0.74-1.08), and highest for homozygous APOE-ε4 (HR 1.52,1.37-1.70). Results did not differ by sex. The association was unaltered after adjustment for baseline LDL or cardiovascular disease. Larger, multiethnic collaborations are ongoing.

scholarly journals Race/ethnicity and other risk of factors associated with cryptosporidiosis as an initial AIDS-defining condition in California, 1980–99

2001 ◽  
Vol 127 (3) ◽  
pp. 535-543 ◽  
Author(s):  
A. KHALAKDINA ◽  
F. TABNAK ◽  
R. K. P. SUN ◽  
J. M. COLFORD
Keyword(s):  
African Americans ◽  
Case Control Study ◽  
Large Population ◽  
Population Based ◽  
Race Ethnicity ◽  
The Difference ◽  
Bisexual Males ◽  
Racial Ethnic ◽  
Biologic Factors ◽  
Control Study

To study whether African-Americans are less likely than whites to present with cryptosporidiosis as an AIDS-defining condition (ADC), a case-control study was conducted using a large, population-based surveillance registry of AIDS patients in California. Data from January 1980 through June 1999 were analysed using risk factor stratification and multivariate logistic regression to evaluate confounding by other risk factors such as gender, injection drug use (IDU), CD4 counts, age and sexual orientation. Cases included 1373 subjects with cryptosporidiosis as an ADC and controls included 97419 subjects with other ADC. The results indicate a significantly lower risk for presentation with cryptosporidiosis as an ADC among African-Americans compared with whites (OR vs. whites = 0·5, 95% CI 0·4, 0·7). Additionally, there is evidence that heterosexuals are less likely than homosexual/bisexual males to present with cryptosporidiosis (OR = 0·5, 95% CI 0·4, 0·7). Our analyses also suggest a decreasing risk with increasing age. The possibility that there may be biologic factors or differential lifetime exposures that account for the difference between the racial/ethnic groups merits further investigation.

scholarly journals Cardiovascular risk associated with allopurinol vs. benzbromarone in patients with gout

2021 ◽  
Author(s):  
Eun Ha Kang ◽  
Eun Hye Park ◽  
Anna Shin ◽  
Jung Soo Song ◽  
Seoyoung C Kim
Keyword(s):  
Coronary Revascularization ◽  
Large Population ◽  
Population Based ◽  
Risk Of Death ◽  
Uricosuric Agents ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Underlying Mechanisms

Abstract Aims  With the high prevalence of gout and associated cardiovascular (CV) diseases, information on the comparative CV safety of individual urate-lowering drugs becomes increasingly important. However, few studies examined the CV risk of uricosuric agents. We compared CV risk among patients with gout who initiated allopurinol vs. benzbromarone. Methods and results  Using the Korean National Health Insurance claims data (2002–17), we conducted a cohort study of 124 434 gout patients who initiated either allopurinol (n = 103 695) or benzbromarone (n = 20 739), matched on propensity score at a 5:1 ratio. The primary outcome was a composite CV endpoint of myocardial infarction, stroke/transient ischaemic attack, or coronary revascularization. To account for competing risk of death, we used cause-specific hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes comparing allopurinol initiators with benzbromarone. Over a mean follow-up of 1.16 years, 2258 patients developed a composite CV event. The incidence rate of the composite CV event was higher in allopurinol initiators (1.81 per 100 person-years) than benzbromarone (1.61 per 100 person-years) with a HR of 1.22 (95% CI 1.05–1.41). The HR for all-cause mortality was 1.66 (95% CI 1.43–1.93) among allopurinol initiators compared with benzbromarone. Conclusion  In this large population-based cohort of gout patients, allopurinol was associated with an increased risk of composite CV events and all-cause mortality compared to benzbromarone. Benzbromarone may reduce CV risk and mortality in patients with gout, although more studies are necessary to confirm our findings and to advance our understanding of the underlying mechanisms.

scholarly journals Survival for Patients With Invasive Cutaneous Melanoma Among Ethnic Groups: The Effects of Socioeconomic Status and Treatment

2008 ◽  
Vol 26 (1) ◽  
pp. 66-75 ◽  
Author(s):  
Jason A. Zell ◽  
Pelin Cinar ◽  
Mehrdad Mobasher ◽  
Argyrios Ziogas ◽  
Frank L. Meyskens ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
African Americans ◽  
Cutaneous Melanoma ◽  
Census Data ◽  
Early Stage ◽  
Large Population ◽  
Poor Survival ◽  
Anatomic Site ◽  
Risk Of Death ◽  
Increased Risk

PurposeAlthough uncommon, melanoma is associated with poor survival characteristics among African Americans and Hispanics compared with non-Hispanic whites (NHWs). Low socioeconomic status (SES) is also associated with poor survival among patients with melanoma, but it is not known whether this is because of SES itself or because of treatment disparities. We set out to determine this by using the large, population-based California Cancer Registry (CCR) database as a model.Patients and MethodsWe conducted a case-only analysis of CCR data (1993 to 2003), including a descriptive analysis of relevant clinical variables and SES. The SES variable used has been derived from principle component analysis of census block-level CCR data that was linked to census data to address seven indicators of SES. Univariate analyses of overall survival (OS) were conducted using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazard ratios (HRs).ResultsA total of 39,049 incident patient cases of cutaneous melanoma, including 36,694 in NHWs; 127 in African Americans; 1,996 in Hispanics; and 262 in Asian-Americans, were analyzed. Higher SES was associated with an early stage at presentation (P < .0001), with treatment with surgery (P = .0005), and with prolonged survival (P < .0001). After adjustments for age, sex, histology, American Joint Committee on Cancer stage, anatomic site, treatment, and SES, a statistically significant increased risk of death was observed for African Americans compared with NHWs (HR, 1.60; 95% CI, 1.17 to 2.18); no survival differences were noted for Asians or Hispanics compared with NHWs in the adjusted analysis.ConclusionLow SES independently predicts poor outcome among patients with cutaneous melanoma. However, the poor OS observed for African American patients with melanoma is not explained by differences in treatment or SES.

scholarly journals Survival of patients with rare diseases: a population-based study in Tuscany (Italy)

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Francesca Gorini ◽  
Alessio Coi ◽  
Lorena Mezzasalma ◽  
Silvia Baldacci ◽  
Anna Pierini ◽  
...  
Keyword(s):  
Rare Diseases ◽  
Proportional Hazards ◽  
Large Population ◽  
Circulatory System ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Public Health Issue ◽  
Risk Of Death ◽  
Increased Risk ◽  
Circulatory System Diseases

Abstract Background Rare diseases (RDs) encompass a heterogeneous group of life-threatening or chronically debilitating conditions that individually affect a small number of subjects but overall represent a major public health issue globally. There are still limited data on RD burden due to the paucity of large population-based epidemiological studies. The aim of this research was to provide survival estimates of patients with a RD residing in Tuscany, Italy. Methods Cases collected in the Rare Diseases Registry of Tuscany with diagnosis between 1st January 2000 and 31th December 2018 were linked to the regional health databases in order to retrieve information on mortality of all subjects. Survival at 1, 5 and 10 years from diagnosis with 95% confidence intervals (CI) was estimated by sex, age class, nosological group and subgroup using the Kaplan–Meier method. The effect of sex, age and period of diagnosis (years 2000–2009 or 2010–2018) on survival was estimated using Cox proportional hazards regression. Results Survival at 1, 5 and 10 years from diagnosis was 97.3%, 88.8% and 80.8%, respectively. Respiratory diseases and peripheral and central nervous system disorders were characterized by the lowest survival at 5 and 10 years. Despite a modest higher prevalence of RDs among females (54.0% of the total), male cases had a significant increased risk of death (hazard ratio, HR 1.48, 95% CI 1.38–1.58). Cases diagnosed during 2010–2018 period had a risk of death significantly lower than those diagnosed during 2000–2009 (HR 0.81, 95% CI 0.82–0.96), especially for immune system disorders (HR 0.48, 95% CI 0.26–0.87), circulatory system diseases (HR 0.61, 95% CI 0.45–0.84) and diseases of the musculoskeletal system and connective tissue (HR 0.64, 95% CI 0.49–0.84). Conclusions An earlier diagnosis as well as the improvement in the efficacy of treatment resulted in a decreased risk of death over the years for specific RDs. The linkage between a population-based registry and other regional databases exploited in this study provides a large and accurate mass of data capable of estimating patients’ life-expectancy and increasing knowledge on the collective burden of RDs.

scholarly journals Incidence of Venous Thromboembolism and Impact on Mortality in Patients with Primary CNS Lymphoma: A Population Based Study

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 754-754
Author(s):  
Anjlee Mahajan ◽  
Ann M Brunson ◽  
Theresa H.M. Keegan ◽  
Aaron S. Rosenberg ◽  
Ted Wun
Keyword(s):  
Major Bleeding ◽  
Proportional Hazards ◽  
Large Population ◽  
Steering Committee ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Population Based Study ◽  
Risk Of Death ◽  
Proportional Hazards Regression ◽  
Increased Risk

Abstract Background: Venous thromboembolism (VTE) is a known complication of cancer, with a high incidence in patients with both gliomas and lymphoma. Recent studies have shown a high risk of intracranial bleeding in glioma patients treated for VTE with anticoagulation. To date, there are no large, population-based studies describing the incidence of VTE in patients with primary central nervous system lymphoma (PCNSL). Methods: Using the California Cancer Registry, we identified patients with a first histologic diagnosis of PCNSL from 2005-2014 and linked these cases to the California hospitalization and emergency department databases. Patients with a VTE within 6 months prior to PCNSL diagnosis were excluded (n=11). We calculated cumulative incidence of VTE and major bleeding and associated 95% confidence intervals (CI), adjusted for the competing risk of death. Multivariable Cox proportional hazards regression models, using the methods of Fine and Gray to adjust for competing risk of death, were used to analyze factors associated with VTE and major bleeding. Models included sex, race/ethnicity, age at diagnosis, neighborhood sociodemographic status, health insurance at diagnosis, Elixhauser comorbidities, HIV status, initial treatment (chemotherapy, radiation, or CNS procedure), and prior VTE (&gt; 6 months prior to diagnosis). The major bleeding model additionally included VTE type as a time dependent covariate. The association of VTE and major bleeding with PCNSL-specific mortality was analyzed using multivariable Cox proportional hazards regression models; VTE and major bleeding were included as time dependent covariates. Results are presented as adjusted hazard ratios (HR) and 95% CI. Results: There were 992 patients with a PCNSL identified. VTE occurred in 143 patients (14.4%). Of the VTE events, 52% were pulmonary emboli [(PE +/- deep vein thrombosis (DVT)], 23% proximal DVT and 22% distal DVT. The 3- and 12-month cumulative incidences of VTE were 10.2% (CI: 8.4-12.2%) and 13.6% (CI: 11.5-15.8%), respectively (Figure 1). Patients who received chemotherapy had over 2-fold increased risk of developing VTE (HR=2.42, CI: 1.33-4.42) compared to those who did not receive chemotherapy, and those who received radiation were also at increased risk of VTE (HR=1.56 CI: 1.07-2.27). Asian/Pacific Islanders had a decreased risk of VTE compared to non-Hispanic Whites (HR=0.37, CI: 0.21-0.66). Major bleeding occurred in 156 patients (15.7%). Of the major bleeding events, 53% were intracranial hemorrhage, 33% were gastrointestinal bleeds, 12% of patients required a transfusion and 3% had unspecified bleeding. The 3- and 12-month cumulative incidences of major bleeding were 9.8% (CI: 8.1-11.8%) and 13.2% (CI: 11.1-15.3%), respectively (Figure 2). PE and proximal DVT were associated with increased risk of major bleeding (HR=4.57, CI: 2.43-8.60 and HR=5.95, CI: 2.47-14.34, respectively). In the PCNSL specific mortality models, PE was associated with increased risk of death (HR=1.81, CI: 1.14-2.87), though DVT (proximal or distal) was not. Patients with major bleeding were at over 2-fold increased risk of PCNSL death compared to those without major bleeding (HR=2.34, CI: 1.71-3.19). Conclusions: The incidence of VTE in this large population-based study of patients with PCNSL was high at 14.4%, with most VTE events occurring within the first 3 months after diagnosis. Risk factors associated with VTE included treatment with either chemotherapy or radiation. PE and proximal DVT were associated with increased risk of major bleeding, suggesting these patients may have received anticoagulation, and as recently shown in glioma patients, are at a high risk of intracranial hemorrhage. In addition, PE and major bleeding were both independently associated with higher PCNSL mortality. Disclosures Wun: Janssen: Other: Study steering committee and research support (site PI); Pfizer: Other: Study steering committee and research support (site PI).

scholarly journals Variation in early childhood parental investment in a US birth cohort: The effects of race, socioeconomic status and place.

2016 ◽  
Author(s):  
Corey Sparks
Keyword(s):  
Socioeconomic Status ◽  
Early Childhood ◽  
Birth Order ◽  
Ethnic Groups ◽  
Birth Cohort ◽  
Parental Investment ◽  
Residential Location ◽  
Rural Residence ◽  
Race Ethnicity ◽  
Racial Ethnic

Parental investment can take many forms. This often takes the form of embodied capital. The ability to invest in a child may be compromised by the socioeconomic status, race/ethnicity and residential location of the parents. In addition, differential investment by sex may also play a role. This analysis uses data from a survey of children to examine disparities in parental investment by SES, race/ethnicity and residential location. Results indicate that after controlling for parental SES, children of certain racial/ethnic groups face a disparity in parental investment. This disparity is exacerbated by low parental SES, rural residence, sex and birth order.

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.

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