Neighborhood disadvantage, health status, and health care utilization after blood or marrow transplant: BMTSS report.
Neighborhood disadvantage, health status, and health care utilization after blood or marrow transplant: BMTSS report.
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DOI：
10.1182/bloodadvances.2022007548
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发表时间：
2023-02-14
期刊：
影响因子：
7.5
通讯作者：
Aswani, Monica S.
中科院分区：
文献类型：
--
作者：
Wolfson, Julie A.;Bhatia, Smita;Hageman, Lindsey;Ross, E. S.;Balas, Nora;Bosworth, Alysia;Te, Hok Sreng;Francisco, Liton;Funk, Erin;Hicks, Jessica;Landier, Wendy;Wu, Jessica;Siler, Arianna;Lim, Shawn;Wong, F. Lennie;Armenian, Saro H.;Arora, Mukta;Aswani, Monica S.
生活在弱势社区的BMT幸存者报告说，在其他条件相同的情况下，常规医疗保健的时间更长。生活在弱势社区的BMT幸存者也报告了更差的健康状况，甚至控制了自最近检查以来的时间。生活在弱势社区与健康状况不佳有关。血液或骨髓移植（BMT）幸存者仍然面临慢性健康状况的风险，需要预先管理。我们假设，在骨髓移植幸存者中，邻里的劣势与自我报告的日常卫生保健利用和健康状况较差有关。我们利用了来自BMTSS的数据，这是一项回顾性队列研究，研究了1974年至2014年期间三家机构BMT后生存≥2年的个体的长期结局。这项分析的参与者完成了BMTSS调查（社会人口统计学;慢性健康状况;自常规检查以来的时间;自我报告的健康状况）。地区贫困指数（ADI）代表了社区的劣势;这一17项普查措施的综合指标是一个百分位数排名（0 =最贫困，100 =最贫困）。多变量有序logit回归调整临床因素和个人水平的社会人口统计学，ADI之间的建模关联，自常规检查的时间，和自我报告的健康。在2，857名幸存者中，中位ADI为24（四分位数范围：10-46）。调整自我报告的个人水平的社会经济指标和慢性健康状况，更弱势社区的患者报告自常规检查以来的间隔时间更长（ORADI_continuous = 1.007，P < .001）和健康状况更差（控制自检查以来的时间; ORADI_continuous = 1.005，P = .003）。与生活在最不贫困社区（ADI = 1）的患者相比，生活在最贫困社区（ADI = 100）的患者报告无常规就诊的几率是2倍（ORADI = 1.007^99 = 2.06），报告健康状况不佳的几率是1.65倍（ORADI = 1.005^99 = 1.65）。在骨髓移植幸存者中，获得医疗保健和健康状况与地区劣势有关。这些研究结果可以为解决弱势幸存者长期护理协调和保留问题的战略提供信息。
BMT survivors living in disadvantaged neighborhoods reported a longer time since routine health care, all other things equal. BMT survivors living in disadvantaged neighborhoods also reported poorer health status, even controlling for time since recent check-up. Living in a disadvantaged neighborhood is associated with poor health outcomes. Blood or Marrow Transplant (BMT) survivors remain at risk of chronic health conditions requiring anticipatory management. We hypothesized that among BMT survivors, neighborhood disadvantage was associated with poor self-reported routine health care utilization and health. We leveraged data from BMTSS – a retrospective cohort study examining long-term outcomes among individuals surviving ≥2 y following BMT at three institutions between 1974 and 2014. Participants in this analysis completed the BMTSS survey (sociodemographics; chronic health conditions; time since routine check-up; self-reported health). The Area Deprivation Index (ADI) represented neighborhood disadvantage; this composite indicator of 17 census measures is a percentile rank (0 = least deprived to 100 = most deprived). Multivariable ordered logit regression adjusted for clinical factors and individual-level sociodemographics, modeling associations between ADI, time since routine check-up, and self-reported health. Among 2,857 survivors, median ADI was 24 (interquartile range: 10-46). Adjusting for self-reported individual-level socioeconomic indicators and chronic health conditions, patients in more disadvantaged neighborhoods had higher odds of reporting longer intervals since routine check-up (ORADI_continuous = 1.007, P < .001) and poorer health status (controlling for time since check-up; ORADI_continuous = 1.005, P = .003). Compared with patients living in the least disadvantaged neighborhood (ADI = 1), patients in the most disadvantaged neighborhood (ADI = 100), had twice the odds (ORADI = 1.007^99 = 2.06) of reporting no routine visits and 1.65-times the odds of reporting poor health (ORADI = 1.005^99 = 1.65). In BMT survivors, access to health care and health status are associated with area disadvantage. These findings may inform strategies to address long-term care coordination and retention for vulnerable survivors.
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影响因子：
39.2
作者：
Kind AJ;Jencks S;Brock J;Yu M;Bartels C;Ehlenbach W;Greenberg C;Smith M
通讯作者：
Smith M
影响因子：
4.8
作者：
Armenian SH;Sun CL;Francisco L;Baker KS;Weisdorf DJ;Forman SJ;Bhatia S
通讯作者：
Bhatia S
影响因子：
6.3
作者：
Diez-Roux, AV;Nieto, FJ;Szklo, M
通讯作者：
Szklo, M
影响因子：
5
作者：
Bosma, H;van de Mheen, HD;Mackenbach, JP
通讯作者：
Mackenbach, JP
影响因子：
5.7
作者：
Hermes, Zachary;Maddox, Karen E. Joynt;Wadhera, Rishi K.
通讯作者：
Wadhera, Rishi K.