Logistic regression predicting receipt of any HMA in patients with MDS and duration of HMA therapy among patients who received at least 1 HMA cycle
| . | Adjusted OR (95% CI) . | |
|---|---|---|
| Receipt of HMA . | Receipt of 1-3 vs ≥4 HMA cycles . | |
| Age at index date, y | ||
| 66-74 | Referent | Referent |
| 75-84 | 0.81 (0.76-0.86) | 0.96 (0.86-1.08) |
| ≥85 | 0.41 (0.38-0.44) | 0.78 (0.66-0.93) |
| Sex | ||
| Male | Referent | Referent |
| Female | 0.81 (0.77-0.86) | 0.99 (0.89-1.1) |
| Race | ||
| White | Referent | Referent |
| Black | 0.70 (0.62-0.80) | 1.00 (0.77-1.30) |
| Other | 0.78 (0.68-0.90) | 0.87 (0.66-1.15) |
| No. of cytopenia | ||
| 0 or 1 | Referent | Referent |
| 2 or 3 | 2.08 (1.96-2.20) | 0.69 (0.61-0.78) |
| TB∗ | ||
| Independent | Referent | Referent |
| Low | 3.32 (3.13-3.52) | 1.31 (1.16-1.48) |
| Medium or high | 6.11 (5.53-6.75) | 1.06 (0.90-1.26) |
| DE (BM biopsy) | 12.61 (10.78-14.74) | 0.94 (0.64-1.39) |
| Nursing home | 0.55 (0.47-0.63) | 0.64 (0.46-0.90) |
| Poverty (census tract)† | ||
| Low or missing | Referent | Referent |
| Medium-low | 0.94 (0.86-1.03) | 0.97 (0.82-1.14) |
| Medium-high | 1.04 (0.95-1.14) | 0.92 (0.76-1.10) |
| High | 0.99 (0.89-1.10) | 0.84 (0.68-1.03) |
| Without high school degree‡ | ||
| Low or missing | Referent | Referent |
| Medium-low | 0.91 (0.84-0.99) | 1.04 (0.89-1.22) |
| Medium-high | 0.96 (0.88-1.05) | 1.01 (0.84-1.20) |
| High | 0.88 (0.80-0.98) | 1.15 (0.94-1.41) |
| RUCC§ | ||
| 1 or missing (metro) | Referent | Referent |
| 2 to 3 | 1.06 (0.99-1.14) | 1.14 (1.00-1.30) |
| >3 | 0.93 (0.85-1.02) | 1.06 (0.89-1.26) |
| General internal medicine specialists∥ | ||
| Low or missing | Referent | Referent |
| Medium-low | 0.92 (0.85-1.00) | 1.16 (1.00-1.35) |
| Medium-high | 0.86 (0.79-0.94) | 1.12 (0.94-1.32) |
| High | 0.86 (0.79-0.94) | 0.96 (0.80-1.14) |
| Frailty index¶ | ||
| Nonfrail | Referent | Referent |
| Prefrail | 0.67 (0.59-0.76) | 0.89 (0.71-1.11) |
| Mildly frail | 0.32 (0.28-0.37) | 0.61 (0.48-0.78) |
| Moderately or severely frail | 0.16 (0.13-0.20) | 0.50 (0.34-0.75) |
| HMA type | ||
| Azacitidine | NA | Referent |
| Decitabine | NA | 0.70 (0.62-0.78) |
| . | Adjusted OR (95% CI) . | |
|---|---|---|
| Receipt of HMA . | Receipt of 1-3 vs ≥4 HMA cycles . | |
| Age at index date, y | ||
| 66-74 | Referent | Referent |
| 75-84 | 0.81 (0.76-0.86) | 0.96 (0.86-1.08) |
| ≥85 | 0.41 (0.38-0.44) | 0.78 (0.66-0.93) |
| Sex | ||
| Male | Referent | Referent |
| Female | 0.81 (0.77-0.86) | 0.99 (0.89-1.1) |
| Race | ||
| White | Referent | Referent |
| Black | 0.70 (0.62-0.80) | 1.00 (0.77-1.30) |
| Other | 0.78 (0.68-0.90) | 0.87 (0.66-1.15) |
| No. of cytopenia | ||
| 0 or 1 | Referent | Referent |
| 2 or 3 | 2.08 (1.96-2.20) | 0.69 (0.61-0.78) |
| TB∗ | ||
| Independent | Referent | Referent |
| Low | 3.32 (3.13-3.52) | 1.31 (1.16-1.48) |
| Medium or high | 6.11 (5.53-6.75) | 1.06 (0.90-1.26) |
| DE (BM biopsy) | 12.61 (10.78-14.74) | 0.94 (0.64-1.39) |
| Nursing home | 0.55 (0.47-0.63) | 0.64 (0.46-0.90) |
| Poverty (census tract)† | ||
| Low or missing | Referent | Referent |
| Medium-low | 0.94 (0.86-1.03) | 0.97 (0.82-1.14) |
| Medium-high | 1.04 (0.95-1.14) | 0.92 (0.76-1.10) |
| High | 0.99 (0.89-1.10) | 0.84 (0.68-1.03) |
| Without high school degree‡ | ||
| Low or missing | Referent | Referent |
| Medium-low | 0.91 (0.84-0.99) | 1.04 (0.89-1.22) |
| Medium-high | 0.96 (0.88-1.05) | 1.01 (0.84-1.20) |
| High | 0.88 (0.80-0.98) | 1.15 (0.94-1.41) |
| RUCC§ | ||
| 1 or missing (metro) | Referent | Referent |
| 2 to 3 | 1.06 (0.99-1.14) | 1.14 (1.00-1.30) |
| >3 | 0.93 (0.85-1.02) | 1.06 (0.89-1.26) |
| General internal medicine specialists∥ | ||
| Low or missing | Referent | Referent |
| Medium-low | 0.92 (0.85-1.00) | 1.16 (1.00-1.35) |
| Medium-high | 0.86 (0.79-0.94) | 1.12 (0.94-1.32) |
| High | 0.86 (0.79-0.94) | 0.96 (0.80-1.14) |
| Frailty index¶ | ||
| Nonfrail | Referent | Referent |
| Prefrail | 0.67 (0.59-0.76) | 0.89 (0.71-1.11) |
| Mildly frail | 0.32 (0.28-0.37) | 0.61 (0.48-0.78) |
| Moderately or severely frail | 0.16 (0.13-0.20) | 0.50 (0.34-0.75) |
| HMA type | ||
| Azacitidine | NA | Referent |
| Decitabine | NA | 0.70 (0.62-0.78) |
DE, diagnostic evaluation; NA, not applicable.
This analysis included all patients with MDS (n = 5941) regardless of the type of HMA received, azacitidine (n = 4302) and decitabine (n = 1639).
TB at diagnosis is based on a 16-week window before and after the index date. Low, moderate, and high TBs were defined as 1 to 3, 4 to 7, and ≥8 unique dates of transfusions during the 16-week before and after index date.
Percent individuals with incomes <100% of the federal poverty level (in quartiles).
Educational attainment based on the percent of adults (aged >25 years) without high school diploma.
The 2013 RUCCs are from the US Department of Agriculture’s Economic Research Service website: http://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. The codes form a classification scheme that distinguishes metro counties by the population size of their metro area and nonmetropolitan counties by degree of urbanization and adjacency to a metro area.
Availability of providers per 100 000 population, including for general internal medicine and internal medicine subspecialties (doctors of medicine and doctors of osteopathic medicine).
Frailty was defined by the frailty score defined as: <0.1, nonfrail; 0.1 to 0.19, prefrail; 0.2 to 0.29, mildly frail; ≥0.3, moderately or severely frail.19