Abstract A062: Age-, sex-, and race-related disparities in receipt of HypomethyLating Agents (HMA) for the treatment of myelodysplastic syndrome (MDS)
Authors: Mukherjee Sudipto , Dong Weichuan , Gerds Aaron T. , Carraway Hetty E. , Singh Abhay , Advani Anjali S. , Koroukian Siran M. 
Published: January 2023

Abstract
Objective: Recent data suggest low use of HMAs in patients with MDS in real world. We sought to identify factors associated with HMA use. Methods: Using 2011-2014 Medicare data, we identified individuals ³65 years of age diagnosed with incident MDS during the years 2012-2013 and receiving their care exclusively through the Medicare fee-for-service system. Collected data included age, race, sex, morbidity burden based on their frailty status (robust, pre-frail, mildly frail, moderately, or severely frail), nursing home residence, presence of MDS-related clinical characteristics [cytopenia (0-1 or ³2) and transfusion dependence (independent, low, or medium/high)], area-level socioeconomic measures [percent of individuals with income 100% below the federal poverty level; percent of adults (age &gt; 25 years) without high school diploma; rurality, based on the rural-urban continuum code; and availability of general internal medicine subspecialists per 100,000 population], and receipt of bone marrow biopsy. Among those who received HMA, we grouped patients by the number of complete cycles (1-2, 3-5, or ³6). We used multivariable logistic regression analysis to evaluate the association between demographic characteristics and receipt of HMA, adjusting for MDS-related clinical characteristics, frailty, and socioeconomic measures. Results: Of 49,154 MDS pts, only 16.1% (7,935) received HMA. This percentage ranged from a low of 7.4% among individuals ³85 years of age to a high of 23.2% among those in the 65-74 age group. Receipt of HMA was significantly higher in men than in women (19.0% vs. 12.8%), in Whites than in minoritized patients (16.7% vs. 11.6% in Blacks, and 12.7% in those of Other race), higher among those with 2-3 cytopenias vs. 0-1 cytopenia and highest among those with medium/high transfusion dependence (44.7%). Among those who underwent biopsy, receipt of HMA was at 22.9%. Patients with moderate or severe frailty, and those in a nursing home had significantly lower rates of receipt of HMA. After adjusting for MDS-related clinical variables, frailty and socioeconomic measures, older patients had significantly lower odds than their younger counterparts to receive HMA [adjusted odds ratio (aOR): 0.84, (95% confidence interval: 0.79-0.89), and aOR: 0.43 (0.40-0.47) for those in the 75-84 and ³85 age groups, respectively). Females and minoritized patients had significantly lower odds than men and White patients to receive HMA [(aOR: 0.83 (0.79-0.88) for females; aOR: 0.71 (0.63-0.81) for Blacks, and aOR: 0.78 (0.68-0.89) for patients of Other race). Among those receiving HMA, we did not observe differences in the number of completed cycles by age, race, or sex. Conclusions: In Medicare beneficiaries with MDS, older patients, women, and minoritized patients have significantly lower odds to be treated with HMAs, even after adjusting for MDS-related clinical variables, morbidity burden, and socioeconomic measures. In addition to barriers to access adequate care, these results clearly reflect biases in MDS treatment, favoring younger, White men.
Citation Format: Sudipto Mukherjee, Weichuan Dong, Aaron T. Gerds, Hetty E. Carraway, Abhay Singh, Anjali S. Advani, Siran M. Koroukian. Age-, sex-, and race-related disparities in receipt of HypomethyLating Agents (HMA) for the treatment of myelodysplastic syndrome (MDS) [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A062.