Tamara Thomas

Urban Health Today

A study being presented at the 2024 American Society of Hematology Annual Meeting &amp; Exposition found that US states with more socioeconomic challenges and fewer physicians are less likely to have access to allogeneic hematopoietic cell transplantation (alloHCT) than the national average.
Studies show that only 1 in 3 patients who may need alloHCT receive it. Several factors are responsible for this limitation; some studies have linked physician density with access to care, but the relationship between alloHCT and these factors requires further investigation.
For this study, Samantha Watters, MPH, and colleagues investigated how physician density and social vulnerability (measured by the Minority Health Social Vulnerability Index [MHSVI]) link to unmet needs and alloHCT use in the US. The study included data across all 3,142 US counties.
Watters and colleagues compared a subset of states previously found at risk of poor access to alloHCT due to high unmet needs and low physician density, including Texas, Louisiana, Georgia, Florida, North Carolina, South Carolina, and Nevada.
The researchers found that counties in at-risk states had higher MSHVI, low physician density, and fewer patients receiving alloHCT compared to national data. Watters and colleagues also observed that across the US, having more doctors was strongly associated with higher transplant rates and lower unmet needs. Furthermore, the researchers found that social factors like income and transportation also affected transplant access, especially in vulnerable areas.
In at-risk states, the researchers observed that race/ethnicity and household characteristics were associated with greater odds of accessing alloHCT. However, health care access, housing, and transportation were associated with lower odds of high alloHCT utilization after controlling for physician density.
At the national level, Watters and colleagues observed that socioeconomic status and medical vulnerability were associated with lower odds of living in areas with high alloHCT utilization. Race/ethnicity and housing/transportation were associated with greater odds of high alloHCT utilization. Controlling for physician density, they noticed only socioeconomic status and medical vulnerability remained significant.
Watters and colleagues recommended targeted initiatives and resources for counties with low physician density and high MHSVI to enable more at-risk patients to receive alloHCT. However, the researchers caution that race/ethnicity and household factors capture the characteristics of a diverse population. Therefore, “positive associations with areas of increased alloHCT utilization could be skewed by diverse metropolitan areas,” they noted. As a result, Watters and colleagues suggest that strategies to increase access may need to vary for patients living in metropolitan areas compared to rural areas.
Reference
Watters S, Meyer CL, Preussler JM, Senneka M. <a href="https://ash.confex.com/ash/2024/webprogram/Paper203597.html" target="_blank" rel="noopener">Comparing Access to Allogeneic Hematopoietic Cell Transplant across the United: Physician Density, Minority Health Social Vulnerability Index, Transplant Unmet Need and Utilization</a>. Abstract #3680. Presented at the 2024 American Society of Hematology Annual Meeting &amp; Exposition; December 7-10, 2024; San Diego, California.

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Social Vulnerability, Physician Density Influence Disparities in AlloHCT Utilization

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States with more socioeconomic challenges and fewer physicians are less likely to have access to allogeneic hematopoietic cell transplantation.

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