{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T04:02:46Z","timestamp":1768449766492,"version":"3.49.0"},"reference-count":17,"publisher":"Baishideng Publishing Group Inc.","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World J Transplant"],"abstract":"BACKGROUND<\/jats:p>\n The impact of social determinants of health in allogeneic transplant recipients in low- and middle-income countries is poorly described. This observational study analyzes the impact of place of residence, referring institution, and transplant cost coverage (out-of-pocket vs government-funded vs private insurance) on outcomes after allogeneic hematopoietic stem cell transplantation (alloHSCT) in two of Mexico's largest public and private institutions.<\/jats:p>\n AIM<\/jats:p>\n To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.<\/jats:p>\n METHODS<\/jats:p>\n In this retrospective cohort study, we included adolescents and adults \u2265 16 years who received a matched sibling or haploidentical transplant from 2015-2022. Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico. Three payment groups were compared: Out-of-pocket (OOP), private insurance, and a federal Universal healthcare program \u201cSeguro Popular\u201d. Outcomes were compared between referred and institution-diagnosed patients, and between residents of Nuevo Leon and out-of-state. Primary outcomes included overall survival (OS), categorized by residence, referral, and payment source. Secondary outcomes encompassed early mortality, event-free-survival, graft-versus-host-relapse-free survival, and non-relapse-mortality (NRM). Statistical analyses employed appropriate tests, Kaplan-Meier method, and Cox proportional hazard regression modeling. Statistical software included SPSS and R with tidycmprsk library.<\/jats:p>\n RESULTS<\/jats:p>\n Our primary outcome was overall survival. We included 287 patients, n = 164 who lived out of state (57.1%), and n = 129 referred from another institution (44.9%). The most frequent payment source was OOP (n = 139, 48.4%), followed by private insurance (n = 75, 26.1%) and universal coverage (n = 73, 25.4%). No differences in OS, event-free-survival, NRM, or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution, nor patients who lived in-state vs out-of-state. Patients who covered transplant costs through private insurance had the best outcomes with improved OS (median not reached) and 2-year cumulative incidence of NRM of 14% than patients who covered costs OOP (Median OS and 2-year NRM of 32%) or through a universal healthcare program active during the study period (OS and 2-year NRM of 19%) (P = 0.024 and P = 0.002, respectively). In a multivariate analysis, payment source and disease risk index were the only factors associated with overall survival.<\/jats:p>\n CONCLUSION<\/jats:p>\n In this Latin-American multicenter study, the site of residence or referral for alloHSCT did not impact outcomes. However, access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.<\/jats:p>","DOI":"10.5500\/wjt.v14.i2.91052","type":"journal-article","created":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T10:37:04Z","timestamp":1718275024000},"source":"Crossref","is-referenced-by-count":2,"title":["Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico"],"prefix":"10.5500","volume":"14","author":[{"given":"Andr\u00e9s","family":"G\u00f3mez-De Le\u00f3n","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yesica A","family":"L\u00f3pez-Mora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Garc\u00eda-Z\u00e1rate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Varela-Constantino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio U","family":"Villegas-De Leon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xitlaly J","family":"Gonz\u00e1lez-Leal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ra\u00fal","family":"del Toro-Mijares","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna C","family":"Rodr\u00edguez-Z\u00fa\u00f1iga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan F","family":"Barrios-Ruiz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Mingura-Ledezma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Perla R","family":"Colunga-Pedraza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga G","family":"Cant\u00fa-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9sar H","family":"Guti\u00e9rrez-Aguirre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luz","family":"Tar\u00edn-Arzaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"El\u00edas E","family":"Gonz\u00e1lez-L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"G\u00f3mez-Almaguer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2060","published-online":{"date-parts":[[2024,6,18]]},"reference":[{"key":"B1","unstructured":"World Health Organization. Social determinants of health. Available from: https:\/\/www.who.int\/health-topics\/social-determinants-of-health"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2015.166"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2017.10.009"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33232"},{"key":"B5","unstructured":"Gonz\u00e1lez Block M\u00c1, Reyes Morales H, Hurtado LC, Balandr\u00e1n A, M\u00e9ndez E. Mexico: Health System Review. Health Syst Transit 2020; 22: 1-222"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-017-2278-1"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1177\/20406207221080739"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2021.05.005"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-05-2004"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-03-418202"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2009.07.004"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2021.04.007"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2014.05.011"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2012.248"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2017.1375100"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2019.06.010"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s12529-022-10126-1"}],"container-title":["World Journal of Transplantation"],"original-title":[],"link":[{"URL":"https:\/\/www.wjgnet.com\/2220-3230\/full\/v14\/i2\/91052.htm","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.wjgnet.com\/2220-3230\/full\/v14\/i2\/91052.htm","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T10:37:40Z","timestamp":1718275060000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.wjgnet.com\/2220-3230\/full\/v14\/i2\/91052.htm"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,18]]},"references-count":17,"journal-issue":{"issue":"2"},"alternative-id":["91052"],"URL":"https:\/\/doi.org\/10.5500\/wjt.v14.i2.91052","relation":{},"ISSN":["2220-3230"],"issn-type":[{"value":"2220-3230","type":"print"}],"subject":[],"published":{"date-parts":[[2024,6,18]]}}}