Session: 905. Outcomes Research—Lymphoid Malignancies: Poster II
Hematology Disease Topics & Pathways:
adult, Research, Lymphomas, non-Hodgkin lymphoma, epidemiology, B Cell lymphoma, Clinical Research, health outcomes research, health disparities research, Diversity, Equity, and Inclusion (DEI) , Diseases, aggressive lymphoma, Lymphoid Malignancies, registries, Human, Study Population
Methods: This is a retrospective cohort analysis of patients (>18 years) diagnosed with DLBCL, using data from the Surveillance, Epidemiology and End Results Plus (SEER plus) from 17 registries in the US spanning 20 years from 2000-2019. The SEER program collects data on cancer incidence and survival as population- based cancer registries across 22 U.S. diverse geographic regions. The primary outcome measure was cancer-specific mortality. Multivariable logistic regression was used to analyze clinical, demographic and socio-economic predictors of mortality. Factors significant on univariate analysis were included in the multivariable model. P< 0.01 was used as the threshold for significance due to large sample and multiple comparisons. Data analysis was conducted using Stata/BE version (Statacorp LLC, College Station, TX).
Results: Between 2000 -2019, there were a total of 113,173 patients (n=51,101(45.2%) females) diagnosed with DLBCL. Of these, 80,674 patients had documented Ann Arbor Staging (33.9% Stage IV, 16.8% Stage III, 20.4% Stage II, and 28.8% stage I), at the time of diagnosis. Of the final analyzed sample, 46.5% patients were ≥70yrs, 22.6% 60-69yrs, 15.6% 50-59yrs, and 15.3% ages 19-49yrs at the time of diagnosis. Whites (W) constituted 83.5%, Blacks 6.8%, and Asian Indian/Asian Pacific Islander (AI/API) 8.3%. B-symptoms were documented in the SEER plus database only from 2010 onwards (32.0% patients had ≥1 B-symptoms documented). 59.9% patients were from metropolitan areas with population size more than 1 million and 20.62% patients living in metropolitan areas with population size between 250,000 to 1 million, 19.51% includes patients living in Non-metropolitan areas. Median Household income inflation was adjusted to 2019; 66.6% had a median household income < $75,000, and 33.37% had a median household income ≥$75,000.
Of 113,173 patients, cancer-specific mortality was observed in 42,084 (37.5%) patients. On multivariable analysis, Male patients had higher mortality (Adjusted odds ratio (aOR),1.18; 95% CI, 1.14 -1.22) compared to females. Patients age ≥70 at the time of diagnosis, were associated with higher mortality (aOR,3.12; 95% CI 2.98-3.27) compared to the younger age group (19-49). Whites (W) (aOR,0.76; 95% CI 0.71-0.81) and Asian Indian/Pacific Islander patients (AI/PI) (aOR,0.83; 95% CI 0.77-0.90) had better overall survival compared to blacks. Patients diagnosed with Stage IV disease at the time of diagnosis had higher mortality (aOR,2.46; 95% CI 2.37-2.56) compared to Stage I patients. The unmarried patient population had lower survival (aOR,1.29; 95% CI 1.25–1.33). Income group ≥ $75,000 had lower mortality compared to lower income group (< $75,000) (aOR,0.94; 95% CI 0.91–0.98). Compared with patients living in Metropolitan areas with a population size > 1 million, Non-metropolitan areas had higher mortality (aOR,1.05; 95% CI 1.01–1.10). Patients who received chemotherapy had lower odds of death (aOR,0.51; 95% CI 0.49-0.53). In subgroup analyses, the association between sociodemographic factors and DLBCL specific mortality remained statistically significant across all groups analyzed.
Conclusions : Our study highlights the significant impact of various socioeconomic and sociodemographic disparities affecting the overall survival in DLBCL patients. Despite DLBCL-specific mortality having significantly decreased over the years, black patients, patients with lower household Income, living in non-metropolitan areas and smaller counties with limited access to health care, have considerably higher mortality risk in DLBCL after adjusting for various clinical predictors.
Disclosures: No relevant conflicts of interest to declare.
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