Employment, Insurance, and Financial Experiences of Patients with Chronic Graft-versus-Host Disease in North America
Employment, Insurance, and Financial Experiences of Patients with Chronic Graft-versus-Host Disease in North America
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DOI：
10.1016/j.bbmt.2018.09.040
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发表时间：
2019-03-01
影响因子：
4.3
通讯作者：
Lee, Stephanie J.
中科院分区：
文献类型：
--
作者：
Khera, Nandita;Hamilton, Betty K.;Lee, Stephanie J.
了解慢性移植物抗宿主病(GVHD)对受影响患者的社会经济影响对于帮助改善他们的整体福祉至关重要。使用慢性GVHD联盟的数据，我们描述了这些患者面临的保险、就业和经济挑战，以及与工作/上学能力和相关经济负担相关的因素。在一项多中心慢性GVHD联盟反应措施验证研究中，190名患者(应答率68%；10个中心)完成了一份包含15个项目的横断面问卷，旨在衡量财务状况、收入、就业和保险。多变量Logistic回归模型检验了与经济负担和工作/上学能力相关的因素。受访者的年龄中值为56岁，87%的患者是白人。在非受访者中，较高比例的人在造血细胞移植前收入较低，且大学学历以下。除1名患者外，所有患者都有保险，34%的患者面临慢性GVHD治疗的延迟/被拒绝保险，66%的患者报告了经济负担。有经济负担的患者有更大的抑郁/焦虑和睡眠困难。非白人种族、较低的精神功能和较低的活动分数与经济负担的可能性更大相关。较年轻的年龄、早期的疾病风险和较高的精神功能与能够工作/上学的可能性更大相关。在这一多中心慢性移植物抗宿主病患者队列中，即使在医疗保险覆盖范围内，也观察到了对财务的显著负面影响。未来的研究应该调查潜在的干预措施，以向高危患者提供最佳和负担得起的护理，并防止这一弱势群体出现长期不利的经济后果。(C)2018年美国血液和骨髓移植学会。
Understanding the socioeconomic impact of chronic graft-versus-host disease (GVHD) on affected patients is essential to help improve their overall well-being. Using data from the Chronic GVHD Consortium, we describe the insurance, employment, and financial challenges faced by these patients and the factors associated with the ability to work/attend school and associated financial burdens. A 15-item cross-sectional questionnaire designed to measure financial concerns, income, employment, and insurance was completed by 190 patients (response rate, 68%; 10 centers) enrolled on a multicenter Chronic GVHD Consortium Response Measures Validation Study. Multivariable logistic regression models examined the factors associated with financial burden and ability to work/attend school. The median age of respondents was 56 years, and 87% of the patients were white. A higher proportion of nonrespondents had lower income before hematopoietic cell transplantation and less than a college degree. All but 1 patient had insurance, 34% had faced delayed/denied insurance coverage for chronic GVHD treatments, and 66% reported a financial burden. Patients with a financial burden had greater depression/anxiety and difficulty sleeping. Nonwhite race, lower mental functioning, and lower activity score were associated with a greater likelihood of financial burden. Younger age, early risk disease, and higher mental functioning were associated with a greater likelihood of being able to work/attend school. In this multicenter cohort of patients with chronic GVHD, significant negative effects on finances were observed even with health insurance coverage. Future research should investigate potential interventions to provide optimal and affordable care to at-risk patients and prevent long-term adverse financial outcomes in this vulnerable group. (C) 2018 American Society for Blood and Marrow Transplantation.