Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico  

作　　者：Andrés Gómez-De León Yesica A López-Mora Valeria García-Zárate Ana Varela-Constantino Sergio U Villegas-De Leon Xitlaly J González-Leal Raúl del Toro-Mijares Anna C Rodríguez-Zúñiga Juan F Barrios-Ruiz Victor Mingura-Ledezma Perla R Colunga-Pedraza Olga G Cantú-Rodríguez César H Gutiérrez-Aguirre Luz Tarín-Arzaga Elías E González-López David Gómez-Almaguer 

机构地区：[1]Hematology Service,Universidad Autónoma de Nuevo León,Facultad de Medicina y Hospital Universitario Dr.JoséEleuterio González,Monterrey 64460,Nuevo León,Mexico [2]Hemato-logy Service,Clínica Gómez Almaguer,Monterrey 64710,Nuevo León,Mexico [3]Hematology Service,Instituto Tecnológico de Estudios Superiores de Monterrey,Tec Salud,Escuela de Medicina Ignacio Santos,Monterrey 64710,Nuevo León,Mexico

出　　处：《World Journal of Transplantation》2024年第2期76-87,共12页世界移植杂志

摘　　要：BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,n

关 键 词：Hematopoietic cell transplant Social determinants of health Geography HAPLOIDENTICAL OUT-OF-POCKET Financial toxicity Survival Health services and outcomes Hematopoietic malignancy Aplastic anemia 

分 类 号：R457.7[医药卫生—治疗学]