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Association of Socioeconomic Status with Chronic Graft-versus-Host Disease Outcomes
Betty K Hamilton1, Lisa Rybicki2, Sally Arai3
1Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
Insights
Socioeconomic status (SES) impacts chronic graft-versus-host disease (GVHD) symptom burden and quality of life, but not survival. Higher income and ability to work correlate with better outcomes in GVHD patients.
Area of Science:
- Hematology
- Transplantation Immunology
- Health Services Research
Background:
- Chronic graft-versus-host disease (GVHD) is a significant complication following hematopoietic cell transplantation (HCT).
- Understanding socioeconomic status (SES) associations is crucial due to intensive healthcare needs and impaired physical health in chronic GVHD patients.
- Previous research has not fully elucidated the link between SES and chronic GVHD outcomes.
Purpose of the Study:
- To evaluate the association between socioeconomic status (SES) and survival and quality of life (QOL) in patients with chronic GVHD.
- To determine how income, education, marital status, and work status relate to patient-reported outcomes, nonrelapse mortality (NRM), and overall mortality in chronic GVHD.
- To identify SES factors influencing symptom burden and functional status post-HCT.
Main Methods:
- Analysis of a cohort of 421 patients with chronic GVHD from the Chronic GVHD Consortium Improving Outcomes Assessment study.
- Assessment of socioeconomic indicators including income, education, marital status, and work status.
- Evaluation of associations with patient-reported outcomes (Lee chronic GVHD symptom scores), quality of life (QOL), activity levels, nonrelapse mortality (NRM), and overall mortality.
Main Results:
- Higher income, ability to work, and having a partner were associated with better Lee chronic GVHD symptom scores.
- Higher income, education, and ability to work were linked to better QOL and improved activity.
- Inability to return to work predicted worse overall mortality, but SES indicators were not significantly associated with survival or NRM.
Conclusions:
- Socioeconomic status (SES) is associated with symptom burden and quality of life (QOL) in chronic graft-versus-host disease (GVHD) patients, with higher income linked to less severe symptoms.
- No significant association was found between SES variables and survival or nonrelapse mortality (NRM) in this chronic GVHD cohort.
- Further research is needed to explore psychosocial, biological, and environmental factors mediating the relationship between SES and HCT outcomes.
Abstract:
Chronic graft-versus host disease (GVHD) is a chronic and disabling complication after hematopoietic cell transplantation (HCT). It is important to understand the association of socioeconomic status (SES) with health outcomes in patients with chronic GVHD because of the impaired physical health and dependence on intensive and prolonged health care utilization needs in these patients. We evaluated the association of SES with survival and quality of life (QOL) in a cohort of 421 patients with chronic GVHD enrolled on the Chronic GVHD Consortium Improving Outcomes Assessment study. Income, education, marital status, and work status were analyzed to determine the associations with patient-reported outcomes at the time of enrollment, nonrelapse mortality (NRM), and overall mortality. Higher income (P = .004), ability to work (P < .001), and having a partner (P = .021) were associated with better mean Lee chronic GVHD symptom scores. Higher income (P = .048), educational level (P = .044), and ability to work (P < .001) also were significantly associated with better QOL and improved activity. In multivariable models, higher income and ability to return to work were both significantly associated with better chronic GVHD Lee symptom scores, but income was not associated with activity level, QOL, or physical/mental functioning. The inability to return to work (hazard ratio, 1.82; P = .019) was associated with worse overall mortality, whereas none of the SES indicators were associated with NRM. Income, race, and education did not have statistically significant associations with survival. In summary, we did not observe an association between SES variables and survival or NRM in patients with chronic GVHD, although we found some association with patient-reported outcomes, such as symptom burden. Higher income status was associated with less severe chronic GVHD symptoms. More research is needed to understand the psychosocial, biological, and environmental factors that mediate this association of SES with major HCT outcomes.