All ETDs from UAB

Advisory Committee Chair

Sadeep Shrestha

Advisory Committee Members

Joshua Richman

Katia J Bruxvoort

Wendy Landier

Document Type

Dissertation

Date of Award

2023

Abstract

The objective of this dissertation was to examine the association between modifiable risk factors and subsequent all-cause and cause-specific late mortality among blood or marrow transplantation (BMT) recipients. I analyzed data for participants who were ≥18 years (y) at study participation from the BMT Survivor Study (BMTSS). BMTSS (U01 CA213140, PI: Bhatia) is a cohort study designed to examine the long-term outcome of individuals who survived ≥2y after undergoing BMT between 1974 and 2014, at the University of Alabama at Birmingham, City of Hope, or University of Minnesota. BMTSS also examines outcomes in an unaffected comparison group drawn from the survivors’ siblings. Participation consisted of completion of the BMTSS survey that captured information on participant’s demographics, health habits, mental health, and chronic health conditions. Clinical variables were retrieved from participants’ medical records. To determine the date and cause of death, the cohort was linked with the National Death Index Plus (2020) and with Accurint database on an ongoing basis.For Aim 1, I examined the association between risky health behaviors (smoking [n=3,845], heavy alcohol consumption [n=3,802], and lack of vigorous physical activity [n=3,844]) and all-cause (Cox regression) and cause-specific mortality (sub-distribution hazard regression) after BMT. For the second aim, I examined the association between the frailty phenotype (n=3,825) and all-cause (Cox regression) and cause-specific (sub-distribution hazard regression) late mortality. I examined the magnitude of pre-frailty and frailty in BMT survivors when compared with their biologic siblings (GEE). Among BMT survivors, I examined potential risk factors for being pre-frail or frail (logistic regression). For the third aim, I determined the association between self-rated health (n=3,817) and all-cause (Cox regression) and cause-specific (sub-distribution hazard regression) late mortality. I determined the odds of reporting poor self-rated health among BMT survivors compared with siblings (logistic regression). Risky health behaviors (smoking, heavy alcohol consumption and lack of vigorous physical activity), being pre-frail or frail, and reporting poor SRH were associated with increased hazard of all-cause and cause-specific mortality. The association between potentially modifiable factors and late mortality offers opportunities for development of interventions to improve both the quality and quantity of life after BMT.

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