2025 Theses Doctoral

Disparities Across the Cellular Therapy Care Continuum: Exploring the Role of Neighborhood Socioeconomic Status on Access and Outcomes in the United States.

Dorlette, Danica

Cellular therapies are life-extending treatments for malignant and non-malignant blood disorders. However, persistent social inequities in access and survival limit their full potential. Neighborhood socioeconomic status (nSES)—a composite of area-level attributes such as poverty, education, healthcare access, and resources—has emerged as a critical but underexplored determinant of disparities across the cellular therapy care continuum.

The purpose of this dissertation was to examine how nSES influences access to and outcomes of cellular therapy through three interrelated studies grounded in Andersen’s Behavioral Model of Health Services Use (6th revision).Study 1, a scoping review of 23 studies, synthesized evidence on the influence of nSES on referral, receipt, long-term follow-up, and survival among cellular therapy patients. Study 2 conducted a systematic evaluation of conceptual frameworks and identified Andersen’s Behavioral Model as the most suitable for nursing research on neighborhood deprivation and cancer care access. Study 3 employed a retrospective cohort analysis of 1,943 donor–recipient pairs who underwent matched unrelated donor allogeneic hematopoietic stem cell transplantation for acute leukemias, chronic myeloid leukemia, or myelodysplastic syndrome. This study used multivariable models to examine the joint effects of donor and recipient nSES on 1-year overall survival, disease-free survival, and treatment-related mortality.

Findings demonstrate that neighborhood socioeconomic disadvantage influences multiple points across the care continuum, with the strongest effects observed in therapy receipt and early post-transplant survival. Importantly, Study 3 showed that donor–recipient nSES interactions significantly predicted outcomes in several pairings, with the greatest disparities observed in disease-free survival. Together, these studies establish nSES as a measurable, actionable determinant of equity in cellular therapy and extend the application of a theoretical framework to guide nursing research in this area. Clinical, research, and policy implications include embedding social risk assessment in transplant care, strengthening supportive services, refining neighborhood-level measures, and addressing structural inequities through reinvestment and mobility policies.