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Ethnic differences in chronic health conditions after hematopoietic cell transplantation†
A report from the Bone Marrow Transplant Survivor Study
Article first published online: 19 AUG 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 17, pages 4152–4159, 1 September 2010
How to Cite
Armenian, S. H., Sun, C.-L., Teh, J. B., Arora, M., Baker, K. S., Francisco, L., Forman, S. J. and Bhatia, S. (2010), Ethnic differences in chronic health conditions after hematopoietic cell transplantation. Cancer, 116: 4152–4159. doi: 10.1002/cncr.25157
Presented in part at the 50th Annual Meeting of the American Society of Hematology, San Francisco, California, December 6-9, 2008.
- Issue published online: 23 AUG 2010
- Article first published online: 19 AUG 2010
- Manuscript Accepted: 17 NOV 2009
- Manuscript Revised: 11 NOV 2009
- Manuscript Received: 10 OCT 2009
- chronic health conditions;
- graft-versus-host disease;
- health insurance coverage;
- health-related outcomes;
- hematologic malignancies;
- sociodemographic factors
Hispanics have a greater risk of early treatment failure after hematopoietic stem cell transplantation (HCT) compared with non-Hispanic whites. However, long-term morbidity among Hispanics has not been described.
Health-related outcomes were examined in 159 Hispanic patients and 825 non-Hispanic white patients who underwent HCT between 1974 and 1998 and survived a mean of 8.7 years. Patients completed a detailed questionnaire about sociodemographic factors and the occurrence of chronic health conditions.
Exposure to total body irradiation (TBI) (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.06-3.56; P = .03), the presence of chronic graft versus host disease (GvHD) (OR, 3.99; 95% CI, 1.94-8.24; P = .002), and health insurance coverage (OR, 3.46; 95% CI, 1.5-8.01; P = .004), were associated significantly with severe/life-threatening conditions. Compared with non-Hispanic white patients, Hispanic patients were 53% less likely to report severe/life-threatening conditions (OR, 0.47; 95% CI, 0.27-0.83; P = .009) after adjusting for relevant clinical variables. This effect size was mitigated (OR, 0.56; 95%CI, 0.29-1.08; P = .08) after adjusting for health insurance coverage.
Hispanics were less likely to report severe/life-threatening health conditions after HCT than non-Hispanic whites—a difference that decreased in magnitude and significance after taking health insurance into consideration. Although the current results confirmed the role of TBI and chronic GvHD, in the current study, the role of a lack of health insurance coverage was identified as a mediator of the lower prevalence of self-reported long-term morbidity in Hispanics. Cancer 2010. © 2010 American Cancer Society.