Socioeconomic disparities in mortality after diffuse large B-cell lymphoma in the modern treatment era
Menée à partir de données californiennes portant sur 33 032 patients atteints d'un lymphome diffus à grandes cellules B diagnostiqué sur la période 1988-2009, cette étude compare, en fonction de facteurs socio-économiques et de l'appartenance ethnique, l'évolution de la mortalité spécifique avant et après l'introduction du rituximab en 2001
Despite advances in treatment, including the introduction of rituximab, survival after diffuse large B-cell lymphoma (DLBCL) remains heterogeneous. However, no studies have considered the association between neighborhood socioeconomic status (SES) and race/ethnicity on mortality after DLBCL before (1988-2000) and after (2001-2009) the introduction of rituximab. We studied all 33,032 patients diagnosed with DLBCL in 1988-2009 in California for vital status through December 31, 2010. Patients diagnosed in 2001-2009 versus 1988-2000 had significantly decreased overall and DLBCL-specific mortality. However, those living in lower SES neighborhoods had 34% (95% CI 27%-40%) and 24% (95% CI 16%-32%) higher risks of death from all causes and lymphoma, respectively, than patients in higher SES neighborhoods. The magnitude of mortality disparities by neighborhood SES were more marked in younger (<65 years) than in older patients (≥ 65 years), in married than non-married patients, and after 2000. We concluded that patients living in low SES neighborhoods in California had substantially worse survival after DLBCL, and this disparity was most striking in younger (i.e., not eligible for Medicare-aged) patients, married patients and after the introduction of rituximab. These disparities suggest there are barriers, including inadequate insurance coverage with additional financial burden, to effective treatment among socioeconomically disadvantaged patients.
Blood 2014