Access to bone marrow transplantation for leukemia and lymphoma: the role of sociodemographic factors.
OBJECTIVE
Use of bone marrow transplantation (BMT), a complex, costly treatment for many forms of cancers, has increased significantly in recent years. The increasingly competitive health care marketplace raises concerns about patient access to costly medical procedures such as BMT. We attempted to evaluate patient access to BMT for the treatment of leukemias and lymphomas.


METHODS
We analyzed inpatient hospital discharge data from four states (California, Maryland, Massachusetts, and New York) for 2 years (1988 and 1991) to examine whether the use of BMT for patients with either leukemia or lymphoma varies by sociodemographic characteristics and insurance coverage. We developed a sorting algorithm to collapse the discharge data into patient level records. We used logistic regression to analyze the odds of receiving a BMT stratified by disease type (leukemia or lymphoma).


RESULTS
After controlling for other factors, black patients with leukemia are 51% to 53% as likely as whites, while black patients with lymphoma are 34% to 45% as likely as white patients to undergo a BMT (P < .05). Medicaid, self-pay patients, and Health Maintenance Organization (HMO) enrollees with either leukemia or lymphoma are significantly less likely to undergo a BMT compared with patients with private insurance. Younger patients are significantly more predisposed to undergo a BMT than older patients. The odds of receiving a BMT have increased over time, but the rates of increase vary by state. Consistent with clinical expectations, the relative odds of BMT vary significantly by type of leukemia or lymphoma.


CONCLUSIONS
Substantial variation exists in access to BMT for patients with either leukemia or lymphoma. Black patients, those enrolled in HMOs, those covered by Medicaid, and self-pay patients were less likely to receive a BMT when admitted for either leukemia or lymphoma. These findings raise concerns about access to cancer treatments for patients in the current health care system.
Mitchell
J M
JM
Institute for Health Care Research and Policy, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC, USA. mitchejm@gunet.georgetown.edu
Meehan
K R
KR
Kong
J
J
Schulman
K A
KA
D001741:Black or African American / Q000706:statistics & numerical data; D016026:Bone Marrow Transplantation; D002140:California; D006279:Health Maintenance Organizations; D006297:Health Services Accessibility; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D016015:Logistic Models; D008223:Lymphoma / Q000628:therapy*; D008396:Maryland; D008404:Massachusetts; D008484:Medicaid; D009518:New York; D016017:Odds Ratio; D012959:Socioeconomic Factors; D014481:United States