Characteristics of the study population
| . | No HMA (n (%) . | Any HMA (n (%) . | Azacitidine (n (%) . | Decitabine (n (%) . | Total (n (%) . |
|---|---|---|---|---|---|
| 41 219 . | 7935 . | 5796 . | 2139 . | 49 154 . | |
| Age (y) at index date, n (%) | |||||
| 66-74 | 10 613 (25.75) | 3208 (40.43) | 2263 (39.04) | 945 (44.18) | 13 821 (28.12) |
| 75-84 | 17 191 (41.71) | 3650 (45.9) | 2706 (46.69) | 944 (44.13) | 20 841 (42.4) |
| ≥85 | 13 415 (32.55) | 1077 (13.6) | 827 (14.27) | 250 (11.69) | 14 492 (29.48) |
| Sex, n (%) | |||||
| Female | 19 764 (47.95) | 2891 (36.4) | 2104 (36.3) | 787 (36.79) | 22 655 (46.09) |
| Male | 21 455 (52.05) | 5044 (63.6) | 3692 (63.7) | 1352 (63.21) | 26 499 (53.91) |
| Race, n (%) | |||||
| Black | 2 879 (6.98) | 377 (4.7) | 267 (4.61) | 110 (5.14) | 3 256 (6.62) |
| White | 36 184 (87.78) | 7243 (91.3) | 5317 (91.74) | 1926 (90.04) | 43 427 (88.35) |
| Other | 2 156 (5.23) | 315 (3.9) | 212 (3.66) | 103 (4.82) | 2 471 (5.03) |
| No. of cytopenias, n (%) | |||||
| 0 or 1 | 24 364 (59.11) | 2261 (28.5) | 1719 (29.66) | 542 (25.34) | 26 625 (54.17) |
| 2 or 3 | 16 855 (40.89) | 5674 (71.5) | 4077 (70.34) | 1597 (74.66) | 22 529 (45.83) |
| TB at diagnosis∗(%) | |||||
| Independent | 25 771 (62.52) | 2289 (28.8) | 1745 (30.11) | 544 (25.43) | 28 060 (57.09) |
| Low | 14 068 (34.13) | 4529 (57.1) | 3343 (57.68) | 1186 (55.45) | 18 597 (37.83) |
| Medium or high | 1 380 (3.35) | 1117 (14.1) | 708 (12.22) | 409 (19.12) | 2 497 (5.08) |
| BM biopsy as part of diagnostic evaluation, n (%) | 26 188 (63.53) | 7766 (97.8) | 5676 (97.93) | 2090 (97.71) | 33 954 (69.08) |
| Nursing home | 4 388 (10.65) | 241 (3) | 176 (3.04) | 65 (3.04) | 4 629 (9.42) |
| Poverty (census tract),†n (%) | |||||
| Low or missing | 10 347 (25.1) | 2025 (25.5) | 1472 (25.39) | 553 (25.85) | 12 193 (24.81) |
| Medium-low | 10 531 (25.55) | 1950 (24.6) | 1438 (24.81) | 512 (23.94) | 12 481 (25.39) |
| Medium-high | 10 059 (24.4) | 2065 (26.0) | 1509 (26.04) | 556 (25.99) | 12 124 (24.67) |
| High | 10 282 (24.94) | 1895 (23.9) | 1377 (23.76) | 518 (24.22) | 12 177 (24.77) |
| Without high school degree‡n (%) | |||||
| Low or missing | 10 088 (24.47) | 2078 (26.2) | 1541 (26.58) | 537 (25.1) | 11 987 (24.39) |
| Medium-low | 10 556 (25.61) | 1986 (25.0) | 1467 (25.31) | 519 (24.26) | 12 542 (25.52) |
| Medium-high | 10 316 (25.03) | 2025 (27.4) | 1486 (25.64) | 539 (25.2) | 12 341 (25.11) |
| High | 10 259 (24.89) | 1846 (23.3) | 1302 (22.46) | 544 (25.43) | 12 105 (24.63) |
| RUCC,§n (%) | |||||
| 1 or missing (metro) | 21 247 (51.55) | 3721 (46.9) | 2704 (46.65) | 1017 (47.54) | 24 789 (50.43) |
| 2 to 3 | 12 608 (30.59) | 2656 (33.5) | 1965 (33.9) | 691 (32.3) | 15 264 (31.05) |
| >3 | 7 364 (17.87) | 1558 (19.6) | 1127 (19.44) | 431 (20.15) | 8 922 (18.15) |
| Availability of providers∥(%) | |||||
| Low or missing | 10 140 (24.6) | 2274 (28.6) | 1657 (28.58) | 617 (28.84) | 12 235 (24.89) |
| Medium-low | 10 179 (24.69) | 2076 (26.2) | 1522 (26.26) | 554 (25.9) | 12 255 (24.93) |
| Medium-high | 10 483 (25.43) | 1799 (22.7) | 1358 (23.43) | 441 (20.62) | 12 282 (24.99) |
| High | 10 417 (25.27) | 1786 (22.5) | 1259 (21.72) | 527 (24.64) | 12 203 (24.83) |
| Frailty index¶(%) | |||||
| Nonfrail | 1 006 (2.4) | 477 (6.0) | 360 (6.2) | 117 (5.5) | 1 483 (3.0) |
| Prefrail | 19 202 (46.6) | 5230 (66.0) | 3807 (65.7) | 1423 (66.5) | 24 432 (49.7) |
| Mildly frail | 15 971 (38.8) | 2005 (25.3) | 1463 (25.2) | 542 (25.3) | 17 976 (36.6) |
| Moderately or severely frail | 5 040 (12.2) | 223 (2.8) | 166 (2.9) | 57 (2.7) | 5 263 (10.7) |
| . | No HMA (n (%) . | Any HMA (n (%) . | Azacitidine (n (%) . | Decitabine (n (%) . | Total (n (%) . |
|---|---|---|---|---|---|
| 41 219 . | 7935 . | 5796 . | 2139 . | 49 154 . | |
| Age (y) at index date, n (%) | |||||
| 66-74 | 10 613 (25.75) | 3208 (40.43) | 2263 (39.04) | 945 (44.18) | 13 821 (28.12) |
| 75-84 | 17 191 (41.71) | 3650 (45.9) | 2706 (46.69) | 944 (44.13) | 20 841 (42.4) |
| ≥85 | 13 415 (32.55) | 1077 (13.6) | 827 (14.27) | 250 (11.69) | 14 492 (29.48) |
| Sex, n (%) | |||||
| Female | 19 764 (47.95) | 2891 (36.4) | 2104 (36.3) | 787 (36.79) | 22 655 (46.09) |
| Male | 21 455 (52.05) | 5044 (63.6) | 3692 (63.7) | 1352 (63.21) | 26 499 (53.91) |
| Race, n (%) | |||||
| Black | 2 879 (6.98) | 377 (4.7) | 267 (4.61) | 110 (5.14) | 3 256 (6.62) |
| White | 36 184 (87.78) | 7243 (91.3) | 5317 (91.74) | 1926 (90.04) | 43 427 (88.35) |
| Other | 2 156 (5.23) | 315 (3.9) | 212 (3.66) | 103 (4.82) | 2 471 (5.03) |
| No. of cytopenias, n (%) | |||||
| 0 or 1 | 24 364 (59.11) | 2261 (28.5) | 1719 (29.66) | 542 (25.34) | 26 625 (54.17) |
| 2 or 3 | 16 855 (40.89) | 5674 (71.5) | 4077 (70.34) | 1597 (74.66) | 22 529 (45.83) |
| TB at diagnosis∗(%) | |||||
| Independent | 25 771 (62.52) | 2289 (28.8) | 1745 (30.11) | 544 (25.43) | 28 060 (57.09) |
| Low | 14 068 (34.13) | 4529 (57.1) | 3343 (57.68) | 1186 (55.45) | 18 597 (37.83) |
| Medium or high | 1 380 (3.35) | 1117 (14.1) | 708 (12.22) | 409 (19.12) | 2 497 (5.08) |
| BM biopsy as part of diagnostic evaluation, n (%) | 26 188 (63.53) | 7766 (97.8) | 5676 (97.93) | 2090 (97.71) | 33 954 (69.08) |
| Nursing home | 4 388 (10.65) | 241 (3) | 176 (3.04) | 65 (3.04) | 4 629 (9.42) |
| Poverty (census tract),†n (%) | |||||
| Low or missing | 10 347 (25.1) | 2025 (25.5) | 1472 (25.39) | 553 (25.85) | 12 193 (24.81) |
| Medium-low | 10 531 (25.55) | 1950 (24.6) | 1438 (24.81) | 512 (23.94) | 12 481 (25.39) |
| Medium-high | 10 059 (24.4) | 2065 (26.0) | 1509 (26.04) | 556 (25.99) | 12 124 (24.67) |
| High | 10 282 (24.94) | 1895 (23.9) | 1377 (23.76) | 518 (24.22) | 12 177 (24.77) |
| Without high school degree‡n (%) | |||||
| Low or missing | 10 088 (24.47) | 2078 (26.2) | 1541 (26.58) | 537 (25.1) | 11 987 (24.39) |
| Medium-low | 10 556 (25.61) | 1986 (25.0) | 1467 (25.31) | 519 (24.26) | 12 542 (25.52) |
| Medium-high | 10 316 (25.03) | 2025 (27.4) | 1486 (25.64) | 539 (25.2) | 12 341 (25.11) |
| High | 10 259 (24.89) | 1846 (23.3) | 1302 (22.46) | 544 (25.43) | 12 105 (24.63) |
| RUCC,§n (%) | |||||
| 1 or missing (metro) | 21 247 (51.55) | 3721 (46.9) | 2704 (46.65) | 1017 (47.54) | 24 789 (50.43) |
| 2 to 3 | 12 608 (30.59) | 2656 (33.5) | 1965 (33.9) | 691 (32.3) | 15 264 (31.05) |
| >3 | 7 364 (17.87) | 1558 (19.6) | 1127 (19.44) | 431 (20.15) | 8 922 (18.15) |
| Availability of providers∥(%) | |||||
| Low or missing | 10 140 (24.6) | 2274 (28.6) | 1657 (28.58) | 617 (28.84) | 12 235 (24.89) |
| Medium-low | 10 179 (24.69) | 2076 (26.2) | 1522 (26.26) | 554 (25.9) | 12 255 (24.93) |
| Medium-high | 10 483 (25.43) | 1799 (22.7) | 1358 (23.43) | 441 (20.62) | 12 282 (24.99) |
| High | 10 417 (25.27) | 1786 (22.5) | 1259 (21.72) | 527 (24.64) | 12 203 (24.83) |
| Frailty index¶(%) | |||||
| Nonfrail | 1 006 (2.4) | 477 (6.0) | 360 (6.2) | 117 (5.5) | 1 483 (3.0) |
| Prefrail | 19 202 (46.6) | 5230 (66.0) | 3807 (65.7) | 1423 (66.5) | 24 432 (49.7) |
| Mildly frail | 15 971 (38.8) | 2005 (25.3) | 1463 (25.2) | 542 (25.3) | 17 976 (36.6) |
| Moderately or severely frail | 5 040 (12.2) | 223 (2.8) | 166 (2.9) | 57 (2.7) | 5 263 (10.7) |
metro, metropolitan.
TB at diagnosis is based on a 16-week window before and after the index date; low, moderate, and high TBs were defined as 1 to 3, 4 to 7, and ≥8 unique dates of transfusions, respectively, during the 16 weeks before and after the index date.
Percent individuals with incomes <100% of the federal poverty level (in quartiles).
Educational attainment based on the percent of adults (aged >25 years) without high school diploma.
The 2013 RUCCs are from the US Department of Agriculture’s Economic Research Service website: http://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. The codes form a classification scheme that distinguishes metro counties by the population size of their metro area and nonmetropolitan counties by degree of urbanization and adjacency to a metro area.
Availability of providers per 100 000 population, including for general internal medicine and internal medicine subspecialties (doctors of medicine and doctors of osteopathic medicine).
Frailty was defined by the frailty score defined as ≤0.1, nonfrail; 0.1 to 0.19, prefrail; 0.2 to 0.29, mildly frail; ≥0.3, moderately or severely frail.19