https://orcid.org/0000-0003-2600-6390
TO THE EDITOR:
In a recent study,1 we reported the association of race, ethnicity, and socioeconomic status (SES) with graft-versus-host disease outcomes. In a response to our publication, Fingrut’s letter raises several important points.2 First, they ask whether donor type was included in the multivariate analyses. Second, they question our use of neighborhood poverty and insurance status as separate variables to adjust for SES and instead suggest a composite variable. Third, they suggest that donor age and time to transplantation be added to the model. Finally, they suggest that prospectively collected granular data are required to accurately investigate health disparities.
We confirm that donor type was included as a potential adjustment factor but was not selected to be in the final multivariate model. Donor age and time to transplantation were not included as potential predictors but we think it is unlikely that their inclusion would have changed our conclusions. Regarding our measures of SES status, median income as estimated by ZIP code and insurance status were entered into the model separately as were education level and work status. A composite variable might better capture SES but precise combinations would need to be explored. Finally, we agree that more granular data would allow refined analyses and answers to different questions. There is a trade-off between detailed SES data, ideally collected directly from patients and large registry populations from multiple centers and regions with less detailed data. Both are necessary and complementary to understand the association between these patient factors and transplant outcomes.
Contribution: N.F. and S.J.L. wrote the manuscript and approved the final version.
Conflict-of-interest disclosure: N.F. has been an advisory board member for Incyte; received speaker fees from Incyte; is on the safety monitoring committee for Chronic Graft-versus-Host Disease Consortium; and is the medical monitor for the Blood and Marrow Transplant Clinical Trials Network. S.J.L. reports receiving consulting fees from Mallinckrodt, Equillium, Kadmon, Novartis, Sanofi, and Incyte; receiving research funding from AstraZeneca, Pfizer, Sanofi, and Syndax; receiving drug supply from Janssen; reports being on clinical trial steering committees for Incyte and Sanofi; and reports serving on the board of directors of the National Marrow Donor Program (uncompensated).
Correspondence: Nosha Farhadfar, Sarah Cannon Transplant & Cellular Therapy Program at Methodist Hospital, 4410 Medical Dr, Suite 410, San Antonio, TX 78229; email: nosha.farhadfar@hcahealthcare.com.
