Patterns of Referral for, and Utilization of, Blood and Marrow Transplantation (BMT) By Race

Racial and ethnic disparities have been reported in the utilization of autologous and allogeneic BMT and in the availability of allogeneic donors for minority populations. In addition, adults in general, and minorities in particular, have low rates of participation in research studies. Several factors may lead to under-utilization of BMT and lack of clinical trial participation, such as differential access to care, co-morbidities, tobacco use, obesity and mistrust of the medical system due to previous unethical practices with minorities in research studies. We investigated the low rates of minorities 1) referred for BMT consultation, 2) undergoing BMT as therapy, and 3) participating in biospecimen and survey research at a single U.S. center by performing a population based analysis using New York State (NYS) Department of Health (DOH) Cancer Registry and 2007-2010 U.S. Census Data.  From 2005-2011, 1106 patients aged 18-75 years were referred to our center for BMT consultation, the majority of whom (74%) reside in the 8 counties of Western NY (WNY). The Table compares the race of BMT patients, referrals, cancer cases and general population estimates. Reasons for not receiving a BMT differed by race with European Americans (EAs) mostly due to patient decision (20%) and African Americans (AAs) mostly due to death before BMT (16%). We further examined patient characteristics which might influence referral for BMT consultation and utilization of BMT by conducting a retrospective cohort study of the 1106 BMT referrals who participated in our Databank and Bio-Repository (DBBR) biologic specimen banking (one-time blood sample collection) and epidemiologic questionnaire (written at 9^th grade level, 45 minutes to complete). As shown in the Table, participation in biospecimen research did not vary by race, however AAs were significantly less likely to participate in survey research than EAs and other races. While the minority rates of referrals and BMT may appear low, they reflect the race distribution of the cancer cases and general population in WNY. AAs are equally likely to participate in biospecimen banking, but further study is needed to elucidate reasons for lower participation in survey research. 

Persons aged 18-75 years
	European American	African American	Other
US Census data 2007-2010, 8 counties of WNY	90%	9.5%	<1%
NYS DOH Cancer Registry, 2005-2010 cases of acute and chronic leukemia, lymphoma and myeloma in 8 counties of WNY	91%	8%	<1%
Total Referrals to BMT program at RPCI 2005-2011	90.5%	7%	2.5%
Total Referrals to BMT program at RPCI 2005-2011, and resided in 1 of 8 counties in WNY	90%	8%	2%
All patients who received a BMT at RPCI 2005-2011	92%	6%	2%
Received a BMT at RPCI, 2005-2011 and resided in 1 of 8 counties in WNY	91%	7%	2%
Proportion of BMT referrals who participated in biospecimen research, 2005-2011	95%	95%	88%
Proportion of BMT referrals who participated in survey research, 2005-2011	70%	37%	67%