%0 Journal Article
%T Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico.
%A Gómez-De León A
%A López-Mora YA
%A García-Zárate V
%A Varela-Constantino A
%A Villegas-De Leon SU
%A González-Leal XJ
%A Del Toro-Mijares R
%A Rodríguez-Zúñiga AC
%A Barrios-Ruiz JF
%A Mingura-Ledezma V
%A Colunga-Pedraza PR
%A Cantú-Rodríguez OG
%A Gutiérrez-Aguirre CH
%A Tarín-Arzaga L
%A González-López EE
%A Gómez-Almaguer D
%J World J Transplant
%V 14
%N 2
%D 2024 Jun 18
%M 38947965
暂无%R 10.5500/wjt.v14.i2.91052
%X <B>BACKGROUND: </B>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.<BR><B>OBJECTIVE: </B>To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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, nor patients who lived in-state vs out-of-state. Patients who covered transplant costs through private insurance had the best outcomes with improved OS (median not reached) and 2-year cumulative incidence of NRM of 14% than patients who covered costs OOP (Median OS and 2-year NRM of 32%) or through a universal healthcare program active during the study period (OS and 2-year NRM of 19%) (P = 0.024 and P = 0.002, respectively). In a multivariate analysis, payment source and disease risk index were the only factors associated with overall survival.<BR><B>CONCLUSIONS: </B>In this Latin-American multicenter study, the site of residence or referral for alloHSCT did not impact outcomes. However, access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.