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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico
Andrés Gómez-De León, Yesica A López-Mora, Valeria García-Zárate, Ana Varela-Constantino, Sergio U Villegas-De Leon, Xitlaly J González-Leal, Raúl del Toro-Mijares, Anna C Rodríguez-Zúñiga, Juan F Barrios-Ruiz, Victor Mingura-Ledezma, Perla R Colunga-Pedraza, Olga G Cantú-Rodríguez, César H Gutiérrez-Aguirre, Luz Tarín-Arzaga, Elías E González-López, David Gómez-Almaguer
Andrés Gómez-De León, Yesica A López-Mora, Valeria García-Zárate, Anna C Rodríguez-Zúñiga, Juan F Barrios-Ruiz, Victor Mingura-Ledezma, Perla R Colunga-Pedraza, Olga G Cantú-Rodríguez, César H Gutiérrez-Aguirre, Luz Tarín-Arzaga, David Gómez-Almaguer, Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
Andrés Gómez-De León, Ana Varela-Constantino, Sergio U Villegas-De Leon, Xitlaly J González-Leal, Raúl del Toro-Mijares, Elías E González-López, David Gómez-Almaguer, Hematology Service, Clínica Gómez Almaguer, Monterrey 64710, Nuevo León, Mexico
Ana Varela-Constantino, Sergio U Villegas-De Leon, Xitlaly J González-Leal, Raúl del Toro-Mijares, Elías E González-López, Hematology Service, Instituto Tecnológico de Estudios Superiores de Monterrey, Tec Salud, Escuela de Medicina Ignacio Santos, Monterrey 64710, Nuevo León , Mexico
Author contributions: Gómez-De León A conceptualized the research, gathered and analyzed data, and wrote the paper; López-Mora YA wrote the paper; García-Zárate V gathered and analyzed data; Varela-Constantino A gathered data and wrote the paper; González-Leal XJ gathered and analyzed data; Del Toro-Mijares R gathered data and wrote the paper; Rodríguez-Zúñiga AC gathered and analyzed data; Barrios-Ruiz JF gathered and analyzed data; Mingura-Ledezma V gathered and analyzed data; Colunga-Pedraza PR analyzed data and wrote the paper; Cantú-Rodríguez OG wrote the paper; Gutiérrez-Aguirre CH analyzed data and wrote the paper; Tarín-Arzaga L wrote the paper; González-López EE gathered and analyzed data; Gómez-Almaguer D supervised the research, analyzed data, and wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Research Ethics Committee of the University Hospital "Dr. José Eleuterio González" (Approval No. HE19-00018).
Informed consent statement: Due to the nature of the research, which involved either no risk or minimal risk to participants, it was determined with prior approval from the Ethics Committee that obtaining informed consent was not deemed necessary. The absence of potential harm or discomfort to the participants warranted this decision. As such, the study received a waiver of the informed consent form requirement.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at
dgomezalmaguer@gmail.com.
STROBE statement: The authors have read the STROBE Statement checklist, and the manuscript was crafted and edited in adherence to the items outlined in the STROBE Statement checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: David Gómez-Almaguer, FACP, MD, Professor, Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Ave. Madero y Gonzalitos SN, Col. Mitras Centro, Monterrey 64460, Nuevo León, Mexico.
dgomezalmaguer@gmail.com
Received: December 20, 2023
Revised: January 29, 2024
Accepted: March 7, 2024
Published online: June 18, 2024
Processing time: 176 Days and 8.9 Hours
ARTICLE HIGHLIGHTS
Research background
Despite the World Health Organization's recognition of the significance of non-medical factors in health outcomes, existing data primarily originates from high-income countries, leaving a lack of insight into Latin American specifics. The study aims to explore the association between social determinants—specifically, the source of transplant payment, site of referral, and place of residence—and overall survival after allogeneic hematopoietic stem cell transplantation (alloHSCT) in Mexico.
Research motivation
The motivation for this study lies in recognizing the potential impact of social determinants of health on alloHSCT outcomes, and the unique challenges faced by patients in Mexico.
Research objectives
To examine the association between the source of transplant payment, site of referral, and place of residence on overall survival after alloHSCT in Mexico. To compare outcomes based on payment source (out-of-pocket, private insurance, and government-funded programs), place of residence (in-state vs out-of-state), and referral source (local diagnosis and treatment vs referred from another institution). To analyze the impact of social determinants, particularly financial barriers, on early mortality, event-free survival, graft-versus-host-relapse free survival, and non-relapse mortality after alloHSCT.
Research methods
Adopting a retrospective cohort design, this study includes patients from two major alloHSCT centers in Mexico, covering the period from 2015 to 2022. Statistical methods such as chi-square tests, t-tests, Kaplan Meier method, and Cox proportional hazard regression modeling were employed to analyze patient demographics, diagnostic characteristics, transplant procedures, and outcomes.
Research results
The study found that the site of residence or referral for hematopoietic stem cell transplantation (HSCT) did not significantly affect outcomes. However, access to private insurance coverage for allogeneic HSCT was associated with improved overall survival (OS) and reduced non-relapse mortality (NRM) when compared to patients covering expenses out-of-pocket or through government-funded programs.
Research conclusions
The study proposes that in allogeneic transplant recipients in low- and middle-income countries, the impact of social determinants of health, specifically the place of residence and transplant cost coverage, influences outcomes after hematopoietic cell transplantation. It suggests that access to healthcare coverage is associated with improved OS and reduced NRM.
Research perspectives
Future research in this field should focus on developing strategies to intervene and reduce economic barriers. Ongoing studies should continue to explore the broader impact of social determinants of health on healthcare delivery, especially in regions where disparities may be heightened.
