Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL.
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
Blood Adv. 2023 Feb 14;7(3):293-301. doi: 10.1182/bloodadvances.2022007548.
Living in a disadvantaged neighborhood is associated with poor health outcomes. Blood or Marrow Transplant (BMT) survivors remain at risk of chronic health conditions requiring anticipatory management. We hypothesized that among BMT survivors, neighborhood disadvantage was associated with poor self-reported routine health care utilization and health. We leveraged data from BMTSS - a retrospective cohort study examining long-term outcomes among individuals surviving ≥2 y following BMT at three institutions between 1974 and 2014. Participants in this analysis completed the BMTSS survey (sociodemographics; chronic health conditions; time since routine check-up; self-reported health). The Area Deprivation Index (ADI) represented neighborhood disadvantage; this composite indicator of 17 census measures is a percentile rank (0 = least deprived to 100 = most deprived). Multivariable ordered logit regression adjusted for clinical factors and individual-level sociodemographics, modeling associations between ADI, time since routine check-up, and self-reported health. Among 2,857 survivors, median ADI was 24 (interquartile range: 10-46). Adjusting for self-reported individual-level socioeconomic indicators and chronic health conditions, patients in more disadvantaged neighborhoods had higher odds of reporting longer intervals since routine check-up (ORADI_continuous = 1.007, P < .001) and poorer health status (controlling for time since check-up; ORADI_continuous = 1.005, P = .003). Compared with patients living in the least disadvantaged neighborhood (ADI = 1), patients in the most disadvantaged neighborhood (ADI = 100), had twice the odds (ORADI = 1.007^99 = 2.06) of reporting no routine visits and 1.65-times the odds of reporting poor health (ORADI = 1.005^99 = 1.65). In BMT survivors, access to health care and health status are associated with area disadvantage. These findings may inform strategies to address long-term care coordination and retention for vulnerable survivors.
生活在贫困社区与健康状况不佳有关。血液或骨髓移植（BMT）幸存者仍然存在发生慢性健康状况的风险，需要进行预期管理。我们假设，在 BMT 幸存者中，社区劣势与自我报告的常规保健利用和健康状况不佳有关。我们利用了 BMTSS 的数据 - 这是一项回顾性队列研究，研究了 1974 年至 2014 年间在三个机构接受 BMT 治疗且存活时间超过 2 年的个体的长期结局。本分析中的参与者完成了 BMTSS 调查（社会人口统计学；慢性健康状况；常规检查后时间；自我报告的健康状况）。区域贫困指数（ADI）代表社区劣势；这是 17 项人口普查措施的综合指标，是一个百分比排名（0 表示最贫困，100 表示最富裕）。多变量有序逻辑回归调整了临床因素和个体水平的社会人口统计学因素，模型中考虑了 ADI、常规检查后时间和自我报告的健康状况之间的关联。在 2857 名幸存者中，ADI 的中位数为 24（四分位距：10-46）。在调整自我报告的个体水平社会经济指标和慢性健康状况后，处于劣势社区的患者报告常规检查后时间间隔较长的可能性更高（ORADI_continuous=1.007，P<.001），健康状况较差（控制检查后时间；ORADI_continuous=1.005，P=.003）。与生活在最不贫困社区（ADI=1）的患者相比，生活在最贫困社区（ADI=100）的患者报告没有常规就诊的可能性高两倍（ORADI=1.007^99=2.06），报告健康状况不佳的可能性高 1.65 倍（ORADI=1.005^99=1.65）。在 BMT 幸存者中，获得医疗保健和健康状况与地区劣势有关。这些发现可能为解决弱势幸存者的长期护理协调和保留问题提供策略。
