Cancer epidemiology · 2025
Association between sociodemographic and clinical factors and utilization of hematopoietic cell transplant in acute myeloid leukemia from 2004 to 2020.
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Joshi Utsav, Ravindra Aditya, Loeffler Bradley, Bhetuwal Uttam, Acharya Shishir, Niu Chengu, Pyakuryal Avantika, Bhatt Vijaya Raj, Dhakal Prajwal
Аннотация
INTRODUCTION: This study investigates the influence of sociodemographic and clinical factors on the utilization of hematopoietic cell transplant (HCT) in patients with acute myeloid leukemia (AML) between 2004 and 2020.
METHODS: Patients identified from the National Cancer Database were grouped into two cohorts (2004-2010 and 2011-2019) to assess HCT trends. An additional analysis was conducted for 2020 to characterize HCT use after the onset of the COVID-19 pandemic. Logistic regression and multivariable analysis were used to estimate the influence of patient characteristics on the odds of receiving HCT.
RESULTS: Among 67,895 AML patients, 6968 (10.3 %) underwent HCT, with usage rising from 7.2 % in 2004-13.4 % in 2019. There was a notable increase in HCT utilization among patients > 70 years (0.4 % in 2004-2010-2.5 % in 2011-2019), Black patients (4.6-7.7 %), those with public insurance (3.2-6.2 %), and individuals with higher Charlson Comorbidity Index (CCI 1: 5.3-8.2 %; CCI 2-3: 1.9-4.8 %). Younger patients exhibited a higher likelihood of receiving HCT, with usage declining significantly with age and increasing CCI. Key factors such as race, education, income, insurance status, and AML subtype were significantly associated with HCT utilization (p < 0.01). Remarkably, HCT utilization for AML remained stable at 13.1 % in 2020 amid COVID-19 pandemic, comparable to 2019.
CONCLUSION: The rate of HCT utilization has continued to increase over time, with notable positive trends across various demographic groups. Despite this, substantial barriers related to sociodemographic and clinical factors hinder equitable treatment access, highlighting urgent need to address these inequities to enhance patient outcomes.
METHODS: Patients identified from the National Cancer Database were grouped into two cohorts (2004-2010 and 2011-2019) to assess HCT trends. An additional analysis was conducted for 2020 to characterize HCT use after the onset of the COVID-19 pandemic. Logistic regression and multivariable analysis were used to estimate the influence of patient characteristics on the odds of receiving HCT.
RESULTS: Among 67,895 AML patients, 6968 (10.3 %) underwent HCT, with usage rising from 7.2 % in 2004-13.4 % in 2019. There was a notable increase in HCT utilization among patients > 70 years (0.4 % in 2004-2010-2.5 % in 2011-2019), Black patients (4.6-7.7 %), those with public insurance (3.2-6.2 %), and individuals with higher Charlson Comorbidity Index (CCI 1: 5.3-8.2 %; CCI 2-3: 1.9-4.8 %). Younger patients exhibited a higher likelihood of receiving HCT, with usage declining significantly with age and increasing CCI. Key factors such as race, education, income, insurance status, and AML subtype were significantly associated with HCT utilization (p < 0.01). Remarkably, HCT utilization for AML remained stable at 13.1 % in 2020 amid COVID-19 pandemic, comparable to 2019.
CONCLUSION: The rate of HCT utilization has continued to increase over time, with notable positive trends across various demographic groups. Despite this, substantial barriers related to sociodemographic and clinical factors hinder equitable treatment access, highlighting urgent need to address these inequities to enhance patient outcomes.