Access to health care and health status are negatively associated with neighborhood disadvantage in survivors of blood or marrow transplant (BMT), according to a study published in Blood advances.

Researchers hypothesized neighborhood disadvantage was associated with poor self-reported routine health care utilization and health status among survivors of BMT. The team leveraged data from the Blood or Marrow Transplant Survivor Study (BMTSS), a retrospective cohort study examining long-term outcomes among individuals following BMT at 3 institutions between 1974 and 2014.

Participants completed a survey of sociodemographics, chronic health conditions, time since routine check-up, and self-reported health. The researchers used the area deprivation index (ADI), a percentile rank composite indicator of 17 census measures (0 = least deprived to 100 = most deprived), to represent neighborhood disadvantage. They use multivariable analyses adjusted for clinical and sociodemographic factors to test associations between ADI, time since routine checkup, and self-reported health.

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A total of 2857 survivors (median age, 47 years; interquartile range [IQR], 30-58 years; 53.7% men and 46.3% women) were included in the analysis. The median time from transplant was 9 years (IQR, 5-16) and median ADI was 24 (IQR, 10-46).

After adjusting for self-reported individual-level socioeconomic indicators and chronic health conditions in the multivariable analysis, the researchers found patients in more disadvantaged neighborhoods had higher odds of reporting longer intervals since routine checkup (odds ratio [OR], 1.007; 95% CI, 1.00-1.01; P <.001) and poorer health status, including when controlling for time since checkup (OR, 1.005; 95% CI, 1.00-1.01; P =.003).

They also found patients in the most disadvantaged neighborhoods compared with those living in the least disadvantaged neighborhoods had twice the odds of reporting no routine visits and 1.65-times the odds of reporting poor health.

“Even after controlling for health care utilization, the significant association between area deprivation and poorer self-reported health remained. These findings suggest that access to health care and health status are associated with area disadvantage in [survivors of BMT],” the researchers concluded in their report.

Limitations of the study included the inclusion of data from survivors only, lack of validation of certain self-reported data (such as health care utilization), no assessment of comorbidities prior to BMT, use of a summative index for chronic conditions, and lack of inclusion of late relapse as a covariate.


Wolfson JA, Bhatia S, Hageman L, et al. Neighborhood disadvantage, health status, and health care utilization after blood or marrow transplant: BMTSS report. Blood Adv. 2023;7(3):293-301. doi:10.1182/bloodadvances.2022007548