title: Association of socioeconomic status with long-term outcomes in 1-year survivors of allogeneic hematopoietic cell transplantation.
abstract: The relationship of socioeconomic status (SES) with long-term outcomes in allogeneic hematopoietic cell transplantation (HCT) survivors has not been well described. We studied the association of SES with the outcomes of 283 consecutive allogeneic HCT recipients transplanted between 2003 and 2012 who had survived for at least 1 year in remission. Median annual household income was estimated using Census tract data and from ZIP code of residence. SES categories were determined by recursive partitioning analysis (low SES (<$51 000/year), N=203; high SES (⩾$51 000/year), N=80). In multivariable analyses, low SES patients had higher risks of all-cause mortality (hazard ratio (HR) 1.98, P=0.012) and non-relapse mortality (NRM) (HR 2.22, P=0.028), but similar risks of relapse mortality (HR 1.01, P=0.97) compared with high SES patients. A trend toward better survival and lower NRM for high SES patients with no chronic GVHD was observed; low SES patients without GVHD had similar survival as patients with chronic GVHD. In allogeneic HCT survivors who survive in remission for at least 1 year, SES is associated with long-term survival that is primarily mediated through higher risks of NRM. More research is needed to understand the mechanisms of health-care disparities and interventions to mitigate them.
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Fu
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
authors.forename: L
authors.initials: L
authors.lastname: Rybicki
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D
authors.initials: D
authors.lastname: Abounader
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Andresen
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Bolwell
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Dean
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Gerds
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: B K
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hanna
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: B T
authors.initials: BT
authors.lastname: Hill
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D
authors.initials: D
authors.lastname: Jagadeesh
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Kalaycio
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: H D
authors.initials: HD
authors.lastname: Liu
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: B
authors.initials: B
authors.lastname: Pohlman
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Sobecks
authors.affiliation: Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Majhail
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012923:Social Class; D017741:Survivors; D019172:Transplantation Conditioning / Q000191:economics* / Q000401:mortality; D014184:Transplantation, Homologous / Q000191:economics* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult