Access Challenges in Allogeneic Hematopoietic Cell Transplant: Identifying At-Risk US States by Exploring Social Vulnerability, Physician Density, and Unmet Need
Samantha E. Watters, Christa L. Meyer, Jaime M. Preussler, Mary K.S. Senneka, Jeffery J. Auletta, Dina L.G. BorzekowskiPURPOSE
Access to allogeneic hematopoietic cell transplantation (alloHCT) is limited by factors beyond physician control. A more complete picture of how barriers to alloHCT overlap is needed to target access-related initiatives. This study examined relationships between social vulnerability index (SVI), physician density (PD), and adult alloHCT unmet need to identify states at-risk of access challenges in the United States.
METHODS
For this exploratory retrospective analysis, we aggregated SVI, Physician Compare, and 2018-2022 alloHCT unmet need data across all US counties. We defined PD as hematology-oncology/HCT providers per 10,000 population and dichotomized variables into low (≤50%) and high (>50%) percentiles. We identified counties with high SVI and unmet need and low PD as at-risk. Using multivariable linear regression, we assessed influences on unmet need.
RESULTS
In county-level models across all US counties, lower PD (b = –10.102,
CONCLUSION
We found relationships among SVI, PD, and alloHCT unmet need to identify states at-risk for access impediments. Data can be examined to allocate resources to overcome barriers to alloHCT, with interventions targeting PD and SVI to improve access and equity in care.