Association of social vulnerability index and chimeric antigen receptor T-cell therapy administration, 2018-2023

Chimeric antigen receptor T-cell (CAR T) therapy for patients with relapsed/refractory hematologic malignancies demands numerous visits, which may pose challenges for patients with lower socioeconomic status (SES). The Centers for Disease Control and Prevention publishes the Social Vulnerability Index (SVI), which summarizes area-level SES factors that predict how residents respond to stressors, including a new cancer -diagnosis. We used the nationwide MarketScan commercial and Medicare insurance claims database to analyze the association between SVI and CAR T therapy completion. We performed multivariable logistic regressions (adjusting for patient-level covariates) and found that patients with hematologic malignancies residing in areas of higher SVI (lower SES) have decreased odds of CAR T therapy completion (odds ratio [OR] 0.84 for leukemia, P = .02; OR 0.72 for lymphoma, P < .001; OR 0.70 for myeloma, P < .001). Therefore, strategies to mitigate CAR T disparities may be focused on patients living in areas with higher SVI.