 |
The 130th Annual Meeting of APHA |
|
The 130th Annual Meeting of APHA |
Jessica P. Hwang, MD, MPH, Tony Lam, MS, and Jane M. Geraci, MD, MPH. General Internal Medicine, Ambulatory Treatment and Emergency Care, University of Texas M D Anderson Cancer Center, 1515 Holcombe Boulevard, Box 437, Houston, TX 77030, 713-745-4516, jphwang@mdanderson.org
Objective: To identify the relationship between patient characteristics and bone marrow transplantation (BMT) occurrence among inpatient leukemia hospitalizations in Texas over a one-year period.
Method: Retrospective analysis of the Texas Hospital Inpatient Discharge Public Use Data File for 1999 was performed. We examined 2264 hospitalizations carrying a primary diagnosis of acute or chronic lymphoid, myeloid, monocytic, or other leukemia admitted to one of 418 hospitals in Texas. Of these, 1963 leukemia hospitalizations involved a BMT. Patient characteristics examined included ethnicity, age, payment type, and comorbid conditions. Logistic regression was implemented to construct four models to predict the odds of receiving a BMT. These four models were created based on age as follows: pediatric (birth-19 years), adult (20-64 years), elderly (65 years and older), and a composite of all ages. A p value less than or equal to 0.05 was considered significant.
Results: The all-age model revealed that adults and pediatric patients were significantly more likely to undergo BMT than elderly patients. In considering adults only, patients with traditional commercial insurance were more likely to receive BMT than those with Medicare. A similar trend may exist among patients who are self-pay and patients who are enrolled in other federal programs such as CHAMPUS, Veteran’s Administration, and Worker’s compensation. Adult patients with weight loss and electrolyte abnormalities were more likely to receive BMT as were patients with cardiac valvular disease and hypothyroidism. Adult patients with deficiency anemia were less likely to receive BMT. Elderly patients with comorbidities such as arrhythmia and coagulopathy were more likely to undergo BMT whereas patients with a diagnosis of comorbid solid tumor were less likely to receive BMT. Among the elderly, men were more likely to receive BMT, but payer type was not significant. Interestingly in the pediatric population, no patient characteristic was predictive of receiving BMT.
Conclusions: Age, payment type as well as certain comorbid conditions were associated with the provision of BMT among patients hospitalized for leukemia. Diagnoses such as weight loss, electrolyte abnormalities, arrhythmia, and coagulopathy may be a proxy for overall good health of a patient as these diagnoses may not be listed in complicated patients with multiple conditions.
Learning Objectives:
Keywords: Access and Services, Cancer
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.