Uneven access to CAR T-cell therapy: A socioeconomic snapshot across hematologic cancers.

186 Background: Chimeric antigen receptor (CAR) T-cell therapy has transformed treatment for hematologic malignancies, yet real-world access remains variable. Socioeconomic status (SES), a known determinant of healthcare access and insurance coverage, may influence who ultimately receives this high-cost, high-complexity therapy. We analyzed national inpatient data to assess whether SES disparities exist in CAR T utilization across different malignancy types. Methods: We analyzed the National Inpatient Sample (2019–2021) to identify patients who received CAR T-cell therapy (n = 7,475). SES was assessed using national income quartile designations. We evaluated the proportion of CAR T recipients in the lowest income quartile (0–25%) across disease subtypes: acute lymphoblastic leukemia (ALL), multiple myeloma (MM), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, mantle cell lymphoma, and other hematologic malignancies. Results: Marked disparities were observed across malignancies (p < 0.01). ALL and DLBCL patients had the highest proportions in the lowest income quartile (20.8% and 17.1%, respectively), while MM, follicular lymphoma, and mantle cell lymphoma had lower representation (13.9%, 12.9%, and 16.8%). Other malignancy subtypes also showed low representation (12.2%). These patterns may reflect differences in institutional adoption, referral pathways, and payer approval processes across diseases, resulting in variable access for lower-SES patients. Conclusions: Despite broad clinical indications, CAR T-cell therapy use appears unevenly distributed by socioeconomic status. Lower-income patients remain underrepresented across several disease subtypes. Standardizing referral practices, expanding payer support, and improving navigation infrastructure are critical steps toward equitable access to CAR T-cell therapy in oncology.