Boloori Alireza, Nategh Emisa, Su Christopher T
Milgard School of Business, University of Washington Tacoma, Tacoma, WA 98402, United States.
McDonough School of Business, Georgetown University, Washington, DC 20057, United States.
Oncologist. 2025 Sep 1;30(9). doi: 10.1093/oncolo/oyaf236.
Chimeric antigen receptor T-cell (CAR T) therapy for patients with relapsed/refractory hematologic malignancies demands numerous visits, which may pose challenges for patients with lower socioeconomic status (SES). The Centers for Disease Control and Prevention publishes the Social Vulnerability Index (SVI), which summarizes area-level SES factors that predict how residents respond to stressors, including a new cancer -diagnosis. We used the nationwide MarketScan commercial and Medicare insurance claims database to analyze the association between SVI and CAR T therapy completion. We performed multivariable logistic regressions (adjusting for patient-level covariates) and found that patients with hematologic malignancies residing in areas of higher SVI (lower SES) have decreased odds of CAR T therapy completion (odds ratio [OR] 0.84 for leukemia, P = .02; OR 0.72 for lymphoma, P < .001; OR 0.70 for myeloma, P < .001). Therefore, strategies to mitigate CAR T disparities may be focused on patients living in areas with higher SVI.
嵌合抗原受体T细胞（CAR T）疗法用于复发/难治性血液系统恶性肿瘤患者时需要多次就诊，这可能给社会经济地位较低（SES）的患者带来挑战。疾病控制与预防中心发布了社会脆弱性指数（SVI），该指数总结了区域层面的SES因素，这些因素可预测居民对压力源（包括新的癌症诊断）的反应。我们使用全国性的MarketScan商业保险和医疗保险理赔数据库来分析SVI与CAR T疗法完成情况之间的关联。我们进行了多变量逻辑回归分析（对患者层面的协变量进行调整），发现居住在SVI较高（SES较低）地区的血液系统恶性肿瘤患者完成CAR T疗法的几率降低（白血病的优势比[OR]为0.84，P = 0.02；淋巴瘤的OR为0.72，P < 0.001；骨髓瘤的OR为0.70，P < 0.001）。因此，减轻CAR T治疗差异的策略可能应侧重于居住在SVI较高地区的患者。
