Data from a retrospective observational study revealed that white patients with hematologic malignancies in the United States had significantly higher uptake of telemedicine compared to black patients, reflecting differences that require further exploration.
Data from a retrospective observational study revealed that white patients with hematologic malignancies in the United States had significantly higher uptake of telemedicine compared to black patients, reflecting differences that require further exploration.1
Results from the analysis, which were presented during the 2021 ASH Annual Meeting & Exposition, revealed an overall trade-off for patients with haematological malignancies, with a reduction in personal visits and increased uptake of telemedicine.
During the period of the pandemic in the study, which lasted from March 2020 to February 2021, non-uniform uptake of telemedicine was observed among black patients vs white patients, and it turned out to be true across all diseases and treatments combined (t = 9 , 5, P <0.01), including acute myeloid leukemia (AML) hospitalizations (t = 2.4, P = 0.04), multiple myeloma oral treatment (t = 6.0, P <0.01), and in inpatient treatment with multiple myeloma (t = 2.3, P = 0.04).
Throughout the pandemic period, no reductions in the number of visits to black patients were observed across all diseases and treatment categories relative to the expected rates. During the early pandemic months, from March 2020 to May 2020, a statistically significant reduction of 18% (95% CI PI, 9.9% -25%) was observed in visitation rates of white patients receiving oral medication. The actual visit rate was 1.61 visits per. patient pr. month against an expected visit rate of 2.0 visits per. patient pr. month (95% CI PI, 1.8-2.2).
“These patterns in documented visits reflect potential differences in the use of telemedicine, requiring further investigation into possible complex causes, including economic and societal factors,” said Natalia Neparidze, MD, lead author of the study and an associate professor of internal medicine and hematology at Yale. School of Medicine, said in a poster presentation about the data.
The onset of the COVID-19 pandemic affected healthcare delivery by reducing the number of personal visits and pushing telemedicine to the care front. Differences in these trends across racial groups are not clear. The study presented during the meeting was conducted to further explore racial differences in visits through the pandemic for those with documented active treatment for hematological malignancies.
To do this, investigators utilized data from the nationwide Flatiron Health electronic health record-derived deidentified database, which included information from approximately 280 cancer clinics and approximately 800 treatment sites across the United States.
The analysis included patients with AML, diffuse large-cell B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia, or multiple myeloma. Patients must be at least 18 years old and documented to have received at least 1 systemic treatment, which they received between March 1, 2016 and February 28, 2021.
Treatment types within therapy lines were stratified based on race (white vs black / African American) and treatment type within therapy lines (oral vs hospitalized patient). Oral treatments include oral agents plus outpatient oral infusions. Inpatient treatment could include chemotherapy, bone marrow transplantation and CAR T cell therapy.
To estimate the expected counterfactual monthly visit rates between March 2020 and February 2021, the adaptation of time series forecast models to data on monthly visit rates before the pandemic was used. The differences between expected and actual visits were calculated using cross-correlation analysis to assess for significant differences in visits between black and white patient populations.
The analysis included a total of 24,432 patients; this included 2,343 black patients and 16,218 white patients. Among patients receiving oral treatment in person, 6.6% were black and 32.0% white; 0.9% and 4.7% of patients received oral treatment via telemedicine, respectively. In addition, 4.8% and 46.0% of patients receiving personal hospitalization, respectively, were black and white; 0.5% and 4.7% of the patients received 24-hour treatment via telemedicine, respectively.
- Neparidze N, Lau KW, Wang X, et al. Racial differences in telemedicine admission during the COVID-19 pandemic among patients with haematological malignancies in the United States. Blood. 2021; 138 (suppl 1): 1973. doi: 10.1182 / blood-2021-153787