Socioeconomic Status and Overall Survival Among Patients With Hematological Malignant Neoplasms

Lars Hernández Nielsen; Daniel Tuyet Kristensen; Lasse Hjort Jakobsen; Martin Bøgsted; Henrik Gregersen; Jakob Madsen; Marianne Tang Severinsen; Rasmus Froberg Brøndum

doi:10.1001/jamanetworkopen.2024.1112

Socioeconomic Status and Overall Survival Among Patients With Hematological Malignant Neoplasms

Lars Hernández Nielsen, Daniel Tuyet Kristensen, Lasse Hjort Jakobsen, Martin Bøgsted, Henrik Gregersen, Jakob Madsen, Marianne Tang Severinsen, Rasmus Froberg Brøndum

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

4 Citationer (Scopus)

Abstract

IMPORTANCE: In recent years, there has been a focus on reducing the socioeconomic gap in survival for hematological malignant neoplasms. Understanding recent developments is important to develop further intervention to improve care.

OBJECTIVE: To investigate the temporal trend in associations of socioeconomic status (SES) with survival among 3 aggressive hematological malignant neoplasms: multiple myeloma (MM), acute myeloid leukemia (AML), and diffuse large B-cell lymphoma (DLBCL).

DESIGN, SETTING, AND PARTICIPANTS: This nationwide, population-based cohort study used retrospectively collected data from 3 clinical registries of patients diagnosed in Denmark between January 1, 2005, and December 31, 2020, with follow-up until December 31, 2021. Analyses were stratified by diagnosis year (2005-2009, 2010-2014, and 2015-2020). Participants were patients aged 25 to 65 years with hematological malignant neoplasms. Patients with missing data on education were excluded. Data were analyzed from October 14, 2022, to January 2, 2024.

EXPOSURE: Education was used as a proxy for SES and defined low- and high-SES groups based on the completion of tertiary education.

MAIN OUTCOMES AND MEASURES: The main outcome was overall survival (OS), analyzed using Kaplan-Meier (log rank) method and Cox proportional hazards regression adjusted for age, sex, performance status, comorbidities, and disease-specific prognostic indices. Two-year OS through time and survival difference were estimated using flexible parametric survival models.

RESULTS: A total of 5677 patients (median [IQR] age, 58 [51-62] years; 3177 [57.0%] male) were assessed, including 1826 patients with MM, 1236 patients with AML, and 2509 patients with DLBCL. The 2-year OS increased over time for patients with MM (78.8% [95% CI, 75.4%-82.3%] to 91.4% [95% CI, 89.3%-93.5%]), AML (42.2% [95% CI, 37.8%-47.1%] to 52.7% [95% CI, 48.0%-57.9%]), and DLBCL (80.1% [95% CI, 77.4%-82.8%] to 88.1% [95% CI, 86.0%-90.3%]). For MM and DLBCL, no association of SES with survival was observed after adjustment (MM: hazard ratio [HR], 0.99 [95% CI, 0.85-1.15]; DLBCL: HR, 1.08 [95% CI, 0.91-1.29]). For AML, a negative association was observed between low SES and survival (HR, 1.49 [95% CI, 1.25-1.76]), but the association was attenuated in recent years. The difference in hazard for patients with low SES and AML was observed in the first 2 years after diagnosis.

CONCLUSIONS AND RELEVANCE: These findings suggest that survival has improved among patients with these hematological malignant neoplasms. While patients with MM and DLBCL had increased survival in all groups, disparities were observed in AML outcomes, primarily in the first years after diagnosis. These results suggest that differences originate in factors specific to AML.

Originalsprog	Engelsk
Tidsskrift	JAMA network open
Vol/bind	7
Nummer	3
Sider (fra-til)	e241112
ISSN	2574-3805
DOI	https://doi.org/10.1001/jamanetworkopen.2024.1112
Status	Udgivet - 4 mar. 2024
Udgivet eksternt	Ja

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10.1001/jamanetworkopen.2024.1112

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@article{e551cf0b56994ceca3b75e5fd704e306,

title = "Socioeconomic Status and Overall Survival Among Patients With Hematological Malignant Neoplasms",

abstract = "IMPORTANCE: In recent years, there has been a focus on reducing the socioeconomic gap in survival for hematological malignant neoplasms. Understanding recent developments is important to develop further intervention to improve care.OBJECTIVE: To investigate the temporal trend in associations of socioeconomic status (SES) with survival among 3 aggressive hematological malignant neoplasms: multiple myeloma (MM), acute myeloid leukemia (AML), and diffuse large B-cell lymphoma (DLBCL).DESIGN, SETTING, AND PARTICIPANTS: This nationwide, population-based cohort study used retrospectively collected data from 3 clinical registries of patients diagnosed in Denmark between January 1, 2005, and December 31, 2020, with follow-up until December 31, 2021. Analyses were stratified by diagnosis year (2005-2009, 2010-2014, and 2015-2020). Participants were patients aged 25 to 65 years with hematological malignant neoplasms. Patients with missing data on education were excluded. Data were analyzed from October 14, 2022, to January 2, 2024.EXPOSURE: Education was used as a proxy for SES and defined low- and high-SES groups based on the completion of tertiary education.MAIN OUTCOMES AND MEASURES: The main outcome was overall survival (OS), analyzed using Kaplan-Meier (log rank) method and Cox proportional hazards regression adjusted for age, sex, performance status, comorbidities, and disease-specific prognostic indices. Two-year OS through time and survival difference were estimated using flexible parametric survival models.RESULTS: A total of 5677 patients (median [IQR] age, 58 [51-62] years; 3177 [57.0%] male) were assessed, including 1826 patients with MM, 1236 patients with AML, and 2509 patients with DLBCL. The 2-year OS increased over time for patients with MM (78.8% [95% CI, 75.4%-82.3%] to 91.4% [95% CI, 89.3%-93.5%]), AML (42.2% [95% CI, 37.8%-47.1%] to 52.7% [95% CI, 48.0%-57.9%]), and DLBCL (80.1% [95% CI, 77.4%-82.8%] to 88.1% [95% CI, 86.0%-90.3%]). For MM and DLBCL, no association of SES with survival was observed after adjustment (MM: hazard ratio [HR], 0.99 [95% CI, 0.85-1.15]; DLBCL: HR, 1.08 [95% CI, 0.91-1.29]). For AML, a negative association was observed between low SES and survival (HR, 1.49 [95% CI, 1.25-1.76]), but the association was attenuated in recent years. The difference in hazard for patients with low SES and AML was observed in the first 2 years after diagnosis.CONCLUSIONS AND RELEVANCE: These findings suggest that survival has improved among patients with these hematological malignant neoplasms. While patients with MM and DLBCL had increased survival in all groups, disparities were observed in AML outcomes, primarily in the first years after diagnosis. These results suggest that differences originate in factors specific to AML.",

keywords = "Humans, Male, Middle Aged, Female, Cohort Studies, Retrospective Studies, Hematologic Neoplasms, Multiple Myeloma, Social Class, Lymphoma, Large B-Cell, Diffuse, Leukemia, Myeloid, Acute",

author = "Nielsen, {Lars Hern{\'a}ndez} and Kristensen, {Daniel Tuyet} and Jakobsen, {Lasse Hjort} and Martin B{\o}gsted and Henrik Gregersen and Jakob Madsen and Severinsen, {Marianne Tang} and Br{\o}ndum, {Rasmus Froberg}",

year = "2024",

month = mar,

day = "4",

doi = "10.1001/jamanetworkopen.2024.1112",

language = "English",

volume = "7",

pages = "e241112",

journal = "JAMA network open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "3",

}

Socioeconomic Status and Overall Survival Among Patients With Hematological Malignant Neoplasms. / Nielsen, Lars Hernández; Kristensen, Daniel Tuyet; Jakobsen, Lasse Hjort et al.
I: JAMA network open, Bind 7, Nr. 3, 04.03.2024, s. e241112.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Socioeconomic Status and Overall Survival Among Patients With Hematological Malignant Neoplasms

AU - Nielsen, Lars Hernández

AU - Kristensen, Daniel Tuyet

AU - Jakobsen, Lasse Hjort

AU - Bøgsted, Martin

AU - Gregersen, Henrik

AU - Madsen, Jakob

AU - Severinsen, Marianne Tang

AU - Brøndum, Rasmus Froberg

PY - 2024/3/4

Y1 - 2024/3/4

N2 - IMPORTANCE: In recent years, there has been a focus on reducing the socioeconomic gap in survival for hematological malignant neoplasms. Understanding recent developments is important to develop further intervention to improve care.OBJECTIVE: To investigate the temporal trend in associations of socioeconomic status (SES) with survival among 3 aggressive hematological malignant neoplasms: multiple myeloma (MM), acute myeloid leukemia (AML), and diffuse large B-cell lymphoma (DLBCL).DESIGN, SETTING, AND PARTICIPANTS: This nationwide, population-based cohort study used retrospectively collected data from 3 clinical registries of patients diagnosed in Denmark between January 1, 2005, and December 31, 2020, with follow-up until December 31, 2021. Analyses were stratified by diagnosis year (2005-2009, 2010-2014, and 2015-2020). Participants were patients aged 25 to 65 years with hematological malignant neoplasms. Patients with missing data on education were excluded. Data were analyzed from October 14, 2022, to January 2, 2024.EXPOSURE: Education was used as a proxy for SES and defined low- and high-SES groups based on the completion of tertiary education.MAIN OUTCOMES AND MEASURES: The main outcome was overall survival (OS), analyzed using Kaplan-Meier (log rank) method and Cox proportional hazards regression adjusted for age, sex, performance status, comorbidities, and disease-specific prognostic indices. Two-year OS through time and survival difference were estimated using flexible parametric survival models.RESULTS: A total of 5677 patients (median [IQR] age, 58 [51-62] years; 3177 [57.0%] male) were assessed, including 1826 patients with MM, 1236 patients with AML, and 2509 patients with DLBCL. The 2-year OS increased over time for patients with MM (78.8% [95% CI, 75.4%-82.3%] to 91.4% [95% CI, 89.3%-93.5%]), AML (42.2% [95% CI, 37.8%-47.1%] to 52.7% [95% CI, 48.0%-57.9%]), and DLBCL (80.1% [95% CI, 77.4%-82.8%] to 88.1% [95% CI, 86.0%-90.3%]). For MM and DLBCL, no association of SES with survival was observed after adjustment (MM: hazard ratio [HR], 0.99 [95% CI, 0.85-1.15]; DLBCL: HR, 1.08 [95% CI, 0.91-1.29]). For AML, a negative association was observed between low SES and survival (HR, 1.49 [95% CI, 1.25-1.76]), but the association was attenuated in recent years. The difference in hazard for patients with low SES and AML was observed in the first 2 years after diagnosis.CONCLUSIONS AND RELEVANCE: These findings suggest that survival has improved among patients with these hematological malignant neoplasms. While patients with MM and DLBCL had increased survival in all groups, disparities were observed in AML outcomes, primarily in the first years after diagnosis. These results suggest that differences originate in factors specific to AML.

AB - IMPORTANCE: In recent years, there has been a focus on reducing the socioeconomic gap in survival for hematological malignant neoplasms. Understanding recent developments is important to develop further intervention to improve care.OBJECTIVE: To investigate the temporal trend in associations of socioeconomic status (SES) with survival among 3 aggressive hematological malignant neoplasms: multiple myeloma (MM), acute myeloid leukemia (AML), and diffuse large B-cell lymphoma (DLBCL).DESIGN, SETTING, AND PARTICIPANTS: This nationwide, population-based cohort study used retrospectively collected data from 3 clinical registries of patients diagnosed in Denmark between January 1, 2005, and December 31, 2020, with follow-up until December 31, 2021. Analyses were stratified by diagnosis year (2005-2009, 2010-2014, and 2015-2020). Participants were patients aged 25 to 65 years with hematological malignant neoplasms. Patients with missing data on education were excluded. Data were analyzed from October 14, 2022, to January 2, 2024.EXPOSURE: Education was used as a proxy for SES and defined low- and high-SES groups based on the completion of tertiary education.MAIN OUTCOMES AND MEASURES: The main outcome was overall survival (OS), analyzed using Kaplan-Meier (log rank) method and Cox proportional hazards regression adjusted for age, sex, performance status, comorbidities, and disease-specific prognostic indices. Two-year OS through time and survival difference were estimated using flexible parametric survival models.RESULTS: A total of 5677 patients (median [IQR] age, 58 [51-62] years; 3177 [57.0%] male) were assessed, including 1826 patients with MM, 1236 patients with AML, and 2509 patients with DLBCL. The 2-year OS increased over time for patients with MM (78.8% [95% CI, 75.4%-82.3%] to 91.4% [95% CI, 89.3%-93.5%]), AML (42.2% [95% CI, 37.8%-47.1%] to 52.7% [95% CI, 48.0%-57.9%]), and DLBCL (80.1% [95% CI, 77.4%-82.8%] to 88.1% [95% CI, 86.0%-90.3%]). For MM and DLBCL, no association of SES with survival was observed after adjustment (MM: hazard ratio [HR], 0.99 [95% CI, 0.85-1.15]; DLBCL: HR, 1.08 [95% CI, 0.91-1.29]). For AML, a negative association was observed between low SES and survival (HR, 1.49 [95% CI, 1.25-1.76]), but the association was attenuated in recent years. The difference in hazard for patients with low SES and AML was observed in the first 2 years after diagnosis.CONCLUSIONS AND RELEVANCE: These findings suggest that survival has improved among patients with these hematological malignant neoplasms. While patients with MM and DLBCL had increased survival in all groups, disparities were observed in AML outcomes, primarily in the first years after diagnosis. These results suggest that differences originate in factors specific to AML.

KW - Humans

KW - Male

KW - Middle Aged

KW - Female

KW - Cohort Studies

KW - Retrospective Studies

KW - Hematologic Neoplasms

KW - Multiple Myeloma

KW - Social Class

KW - Lymphoma, Large B-Cell, Diffuse

KW - Leukemia, Myeloid, Acute

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U2 - 10.1001/jamanetworkopen.2024.1112

DO - 10.1001/jamanetworkopen.2024.1112

M3 - Journal article

C2 - 38436954

SN - 2574-3805

VL - 7

SP - e241112

JO - JAMA network open

JF - JAMA network open

IS - 3

ER -

Socioeconomic Status and Overall Survival Among Patients With Hematological Malignant Neoplasms

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