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Neighborhood-poverty linked with poor outcomes in pediatric hematopoietic cell transplantation

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Social determinants of health, including poverty, contribute significantly to health outcomes in the United States, yet their impact on pediatric hematopoietic cell transplantation (HCT) outcomes is poorly understood. We aimed to identify the association between neighborhood-poverty and HCT outcomes for pediatric allogeneic HCT recipients in the Center for International Blood and Marrow Transplant Research (CIBMTR) database.

In this study, 2053 children (age ≤18 years) with malignant disease and 1696 children with non-malignant disease who received a first, allogeneic hematopoietic cell transplantation between 2006-2015, were included. Researchers defined neighborhood-poverty exposure as a priori per U.S. Census definition as living in a high-poverty ZIP code (>=20% of persons below 100% Federal Poverty Level).

Overall survival (OS), defined as time from HCT until death from any cause, was the primary outcome, with secondary outcomes including relapse and transplant-related mortality (TRM) in malignant disease, acute and chronic graft versus host disease (GVHD), an infection in the first 100 days post-HCT.

In the group of children with non-malignant disease, neighborhood-poverty was not associated with any HCT outcome. In children with malignant disease, neighborhood-poverty was associated with an increased risk of TRM but not with inferior OS or any other transplant outcome.

Children with malignant disease who were on Medicaid insurance had inferior OS and increased TRM compared to children who had private insurance.

The authors concluded that further investigations into household-level poverty exposure on HCT outcomes could help inform care delivery interventions for pediatric patients with pediatric malignant disease.


Bona K, Brazauskas R, He N, et al. Neighborhood-poverty and pediatric allogeneic hematopoietic cell transplantation outcomes: A CIBMTR Analysis. Blood. 2020; https://doi.org/10.1182/blood.2020006252.