Association of socioeconomic status with autologous hematopoietic cell transplantation outcomes for lymphoma

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Abstract

Socioeconomic status (SES) is an important determinant of disparities in health care. The association of SES with outcomes in autologous hematopoietic cell transplantation (AHCT) has not been described previously. We conducted a retrospective cohort study of 687 AHCT recipients with lymphoma transplanted between 2003 and 2013. Patients were categorized into low (< $50 000/year) and high SES (≥ $50 000/year). A greater proportion of low SES patients lived farther away from our center (median 54 vs 28 miles), belonged to a racial minority (12 vs 3%), had poorer performance status (4 vs 1%) and had high-risk disease at AHCT (9 vs 5%). Median follow-up was 53 months. In univariable analysis, low SES patients had significantly higher relapse mortality and lower OS and PFS. This was confirmed on multivariable analysis for relapse mortality (HR for high vs low SES: 0.74 (95% confidence interval (CI), 0.54-0.99), P = 0.05), OS (HR 0.74 (0.58-0.95), P = 0.02) and PFS (HR 0.77 (0.63-0.95), P = 0.02). In multivariable analysis of ≥ 1-year progression-free survivors, high SES patients had better OS (HR 0.73, P = 0.05 vs low SES) that was primarily driven by a trend toward lower risk of non-relapse mortality (HR 0.62, P = 0.06). SES is associated with outcomes of AHCT in patients with lymphoma.

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