Prevalence and Impact of Financial Hardship Among New England Pediatric Stem Cell Transplant Families

Prevalence and Impact of Financial Hardship Among New England Pediatric Stem Cell Transplant Families

Bona K; London WB; Guo D; Abel G; Lehmann L; Wolfe J

Biology Of Blood And Marrow Transplantation : Journal Of The American Society For Blood And Marrow Transplantation

2014

PURPOSE: Poverty is correlated with negative health outcomes in pediatric primary care and subspecialties; its association with childhood HSCT patterns of care and clinical outcomes is not known. We describe family-reported financial hardship at a primary referral center in New England, and explore the relationship between measures of poverty and child patterns of care and clinical outcomes. PATIENTS AND METHODS: Forty-five English-speaking parents of children status-post allogeneic HSCT in the prior twelve months completed a one-time survey (response rate 88%). RESULTS: Low-income families defined as ≤200% federal poverty level (FPL) were compared to all others. Eighteen (40%) families reported pre-HSCT incomes ≤200% FPL. Material hardship including food, housing, or energy insecurity was reported by 17 (38%) families in the cohort. Low-income families reported disproportionate transplant-related income losses with 7 (39%) reporting annual income losses of >40% compared to 2 (18%) wealthier families (p=0.02). In univariate analyses, 11 (61%) low-income children experienced Graft Versus Host Disease (GVHD) of any grade in the first 180 days post-HSCT compared to 2 (7%) wealthier children (p=0.004). CONCLUSION: We conclude that low income and in particular, material hardship, are prevalent in a New England pediatric HSCT population and represent targets for improvement in quality of life. The role of poverty in mediating GVHD deserves further investigation in larger studies which can control for known risk factors, and may provide a targetable source of transplant-associated morbidity.

2014-10

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