Abstract
Background: Some specific patient and donor demographic factors have been described and associated with outcomes of hematopoietic stem cell transplantation (HSCT). However, associations with the socioeconomic status (SES) remain controversial as some studies including allogeneic HSCT (allo-HSCT) patients have reported that SES associates with worse long-term outcomes and other studies, including both, allogeneic and autologous HSCT have not found an association between SES and overall survival (OS), non-relapse mortality (NRM) or other outcomes. More importantly, these studies have been performed in developed countries and data from developing regions remains scarce.
Objective: To associate the SES with outcomes in Mexican patients undergoing allo-HSCT at a National Institute of Health located in Mexico City.
Patients and Methods: A retrospective study was performed including 124 consecutive patients undergoing allo-HSCT at the National Institute of Medical Sciences and Nutrition "Salvador Zubiran", from May 1999 to March 2018. SES was established according to the classification assigned by the Department of Social Work (levels I-VII); the lowest level corresponds to 7% out-of-pocket expense (93% subsidized by the Institution) and the highest to 120% (private health insurances). Patients were dichotomized into low SES (levels I-II) and high SES (levels ≥ III). Disease risk index was classified as low, intermediate or high using standard definitions and the HCT-CI score was assigned to each patient. Graft-versus-host disease (GVHD) was evaluated according to NIH guidelines. Endpoints included OS and NRM.
Results: Patient characteristics by SES are shown in Table 1. Age, educational attainment, employment status, and financial support were the sociodemographic characteristics that differed between both groups. There were no differences in GVHD between the two groups. For all the cohort, 30, 100-days, and 1-year NRM was 3.2%, 8.8%, and 14.5%, respectively. Figure 1 shows NRM and OS by SES group.
Conclusion: Although there were differences regarding diagnosis between the two groups (low and high SES), the DRI was the same between them, as well as the HCT-CI. Further, there were no differences between low and high SES in NRM or OS, demonstrating that our HSCT approaches are standardized and all patients can benefit from them despite their financial status, also highlighting that patients with low SES probably had good outcomes as a result of substantial governmental, NGO, and/or institutional subsidy.
No relevant conflicts of interest to declare.
