Health care utilization by adult Hispanic long term survivors of hematopoietic cell transplantation (HCT): report from the bone marrow transplant survivor study

Abstract

6608 Background: A third of long-term HCT survivors report severe or life-threatening chronic health conditions, placing significant demands on the healthcare system for a prolonged period of time. However, utilization patterns of healthcare services among minorities differ from those of non-Hispanic whites in the general population. The aim of this study was to evaluate healthcare utilization by adult long-term Hispanic HCT survivors. Methods: A mailed questionnaire was used to assess self-reported health care utilization in three domains: general contact with healthcare system, general physical examination (GPE), and cancer/HCT-related visit. Eligible individuals had undergone HCT between 1974 and 1998, at 21 years of age or older and survived 2 or more years after HCT. Results: The entire cohort consisted of 818 individuals, including 137 Hispanic survivors. The median age at HCT was 38.3 years (range: 21–68 years) and the median length of follow-up was 6.6 years (range: 2–24 years). A larger proportion of Hispanic survivors had family income < $20,000 (45.6% vs. 8.8% in non-Hispanics, p<0.001), high school or lower education (37.5% vs. 6%, p<0.001), and lacked health insurance (22.4% vs. 4.6%, p<0.001). Overall, 97% of non-Hispanic whites and 92% of Hispanics reported medical contact 11+ years after HCT (p=0.15). Compared to 2–5 years after HCT, the prevalence of GPE increased among non-Hispanic whites (67% to 76%, p for trend =0.05) but remained unchanged among Hispanics (66% to 61%, p for trend=0.68) 11+ years after HCT. On the other hand, while the proportion of non-Hispanic white survivors reporting a Cancer/HCT-related visit decreased from 94% at 2–5 years after HCT to 54% 11+ years after HCT (p for trend<0.001), the comparable figures in Hispanics were 96% and 81% (p for trend=0.03). Conclusion: As compared to non-Hispanic whites, Hispanic survivors are less likely to establish contact with a primary care provider years after the HCT and continue to receive care primarily at Cancer/HCT center for many years following HCT. Future studies of this population are needed to establish the factors responsible for this pattern of healthcare utilization. No significant financial relationships to disclose.