title: Health care utilization by adult Hispanic long-term survivors of hematopoietic stem cell transplantation: report from the Bone Marrow Transplant Survivor Study.
abstract: BACKGROUND
  Long-term hematopoietic cell transplantation (HCT) survivors have a high prevalence of severe and chronic health conditions, placing significant demands on the healthcare system. The objective of the current study was to evaluate and compare the healthcare utilization by adult Hispanic and non-Hispanic white long-term survivors of HCT.
  
  
  METHODS
  A mailed questionnaire was used to assess self-reported healthcare utilization in 3 domains: general contact with healthcare system, general physical examination outside cancer center (GPE), and cancer/HCT center visit. Eligible individuals had undergone HCT between 1974 and 1998, at age > or =21 years, and had survived > or =2 years after HCT.
  
  
  RESULTS
  The cohort included 681 non-Hispanic white and 137 Hispanic survivors. The median age at HCT was 38.3 years, and the median length of follow-up was 6.6 years. Hispanic survivors had lower family income and education and were more likely to lack health insurance. The prevalence of GPE increased significantly over time among non-Hispanic whites (67% at 2-5 years to 76% at 11+ years) but remained unchanged among Hispanics (66% to 61%). Cancer/HCT center visits declined over time among both Hispanics and non-Hispanic whites, but a higher proportion of Hispanics reported cancer/HCT center visits at 11+ years after HCT (81% vs 54%).
  
  
  CONCLUSIONS
  Compared with non-Hispanic whites, Hispanic survivors are less likely to establish contact with primary care providers years after HCT and to continue to receive care at cancer/HCT centers. Future studies of this population are needed to establish the factors responsible for this pattern of healthcare utilization.
authors.affiliation: Division of Pediatric Hematology Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.
authors.forename: Pinki K
authors.initials: PK
authors.lastname: Prasad
authors.forename: Can-Lan
authors.initials: CL
authors.lastname: Sun
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Liton
authors.initials: L
authors.lastname: Francisco
authors.forename: Stephen
authors.initials: S
authors.lastname: Forman
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Sadhna M
authors.initials: SM
authors.lastname: Shankar
mesh_terms: D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D018380:Hematopoietic Stem Cell Transplantation; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*