Does Location Matter? a Population-Based Analysis of Survival after Blood and Marrow Transplantation in Rural Versus Urban Manitobans
Notice bibliographique
Résumé
Abstract Objective: Specialized health services such as blood and marrow transplantation (BMT) are based in large urban centres. A previous study suggested that rural patients may have inferior outcomes after BMT. We hypothesized that rural Manitobans have reduced access to BMT and higher mortality rates after BMT than urban Manitobans. Methods: This population-based historical cohort study was based in Manitoba, Canada, a province of 1.2 million people that is served by a single, publicly funded BMT program. We utilized data from both the Manitoba BMT Program and the provincial Cancer Registry. Consecutive adult Manitobans who underwent BMT at Health Sciences Centre, Winnipeg between 01/1990 and 12/2006 were assessed. We analyzed distance of residence from the BMT centre, disease and BMT characteristics, and calculated overall survival (OS). Secondly, to measure access to BMT, we evaluated all patients with newly diagnosed Hodgkin Lymphoma (HL) during this same period. We compared the proportion of rural and urban Manitobans diagnosed with HL to those who received a BMT for HL. Results: 464 Manitobans underwent BMT (179 rural, 285 urban). Rural Manitobans had inferior 5 year OS (45% vs. 37%, p<0.05). A gradient was apparent; patients who lived < 20 km from the BMT centre had superior 5 year OS, while those furthest away (>200km) had the poorest OS (p<0.05). In a univariate Cox regression model, rural patients had a mortality ratio of 1.18 (p <0.05), and those living 200km or more from Winnipeg had a mortality ratio of 1.40 (p = NS). When adjusted for gender, age at BMT, year of BMT, and graft type, distance from HSC was not a significant predictor of mortality. Only period of BMT and graft type were significant predictors. A relative survival analysis was also conducted. This model included only those variables available in population data (age at BMT, gender, distance from Winnipeg, year of BMT). In univariate analysis, rural patients had an excess mortality ratio of 1.35 (p <0.05), and those living more than 200 km from Winnipeg had had an excess mortality ratio of 1.52 (p = NS). However, in the adjusted relative survival analysis, distance from Winnipeg was not a significant predictor. Again, period of BMT was a significant predictor. 432 Manitobans were diagnosed with HL. 182 (42%) were rural, and 250 (58%) were urban. This was similar to 2006 Canadian census data for Manitoba, (54% urban). In contrast, 69% of patients undergoing transplant for HL were urban. Conclusions: Previous research has suggested that rural patients undergoing BMT have a higher risk of death. Using population-based data from a Canadian province, we were unable to demonstrate this finding. Both the Cox regression model and the relative survival analysis demonstrated non-significant associations between location and mortality after controlling for other variables. This may be due to relatively small number of patients residing 200 or more km from Winnipeg in our study. However, the non-significant relationship may also be due to more comprehensive long-term follow-up of patients within the BMT program. Lastly, there may be under-utilization of BMT in rural populations; this is an area that deserves further study.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».