Social determinants of health predict health outcomes following pediatric allogeneic hematopoietic stem cell transplant

Author:

Klages Kimberly L.123ORCID,Schwartz Laura E.123,Crabtree Endia J. Santee1,Brokamp Cole34,Rasnick Erika4,Dandoy Christopher E.35ORCID,Davies Stella M.35ORCID,Pai Ahna L. H.123ORCID

Affiliation:

1. Patient and Family Wellness Center in the Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA

2. Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA

3. Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA

4. Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA

5. Division of Bone Marrow Transplantation & Immune Deficiency Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA

Abstract

AbstractBackgroundPediatric hematopoietic stem cell transplantation (HCT) is an intensive medical procedure that places substantial financial and logistical burdens on families and is associated with significant health risks, such as graft‐versus‐host disease (GVHD), and infections. The influence of the social determinants of health (SDoH) on outcomes following pediatric HCT is understudied. This study aimed to examine whether SDoH predicts outcomes following pediatric HCT.ProcedureData were collected from 84 children who received HCT (Mage = 5.8 years, SD = 3.7) and their primary caregiver. Detailed demographic information was collected from caregivers at baseline, and child health information was extracted from the electronic medical records. Multivariate logistic regression was used to examine the association between SDoH and health outcomes within a 24‐month period following pediatric HCT.ResultsAfter controlling for malignancy as reason for transplant and donor type, lower family income predicted the incidence of chronic GVHD. Neighborhood deprivation, total family income, public health insurance, caregiver relationship status, caregiver educational attainment, and perceived family financial difficulties did not predict acute GVHD or the number of infections.ConclusionsTotal family income is a simple family indicator of SDoH that predicts chronic GVHD after pediatric allogeneic HCT. These findings provide further support for the importance of screening of child and family SDoH risks to ensure that fundamental needs can be met to mitigate potential health disparities for up to 2 years following pediatric HCT.

Funder

National Science Foundation

National Cancer Institute

Publisher

Wiley

Subject

Oncology,Hematology,Pediatrics, Perinatology and Child Health

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