Socioeconomic status is independently associated with overall survival in patients with multiple myeloma

Abstract

Population-based studies suggest that black patients with multiple myeloma (MM) have a higher mortality rate than white patients. However, other studies suggest that this disparity is related to socioeconomic status (SES) rather than race. To provide clarity on this topic, we reviewed 562 patients diagnosed with MM at our institution. Patients with high SES had a median overall survival (OS) of 62.8 months (95% confidence interval [CI] 43.1-82.6 months), compared to 53.7 months (45.2-62.3 months) and 48.6 months (40.4-56.8 months) for middle and low SES, respectively (p = 0.015). After controlling for race, age, year of diagnosis, severity of comorbidities, stem cell transplant utilization and insurance provider, patients with low SES had a 54% increase in mortality rate relative to patients with high SES. To support our findings, we performed a similar analysis of 45,505 patients with MM from the Surveillance, Epidemiology and End Results-18 (SEER) database. Low SES is independently associated with poorer OS in MM.

Keywords: Multiple myeloma; cancer health disparities; race; socioeconomic status.

Figure 1

Patients in the highest SES tertile (≥ $57,177 median household income) had a median OS of 62.8 months (mos) (95% CI 43.1–82.6 mos), compared to 53.7 mos (45.2–62.3 mos) and 48.6 mos (40.4–56.8 mos) for the middle and lowest tertiles, respectively (p =0.015).

Figure 2

In univariate analysis, there was no difference in OS based on race.

Figure 3

In the SEER-18 registries database, patients in the highest SES tertile (≥ $50,760 median household income) had a median OS of 38.0 mos (95% CI 36.8–39.2 mos), compared to 32 mos (30.9–33.1 mos) and 29 mos (28.1–29.9 mos) for the middle and lowest tertiles, respectively (p <0.001).

Figure 4

In univariate analysis of the SEER-18 registries database, there was no difference in OS based on race.