Multiple Myeloma Incidence and Mortality Around the Globe; Interrelations Between Health Access and Quality, Economic Resources, and Patient Empowerment

Abstract

Background: The interrelation between the worldwide incidence, mortality, and survival of patients with multiple myeloma (MM) and relevant factors such as Health Care Access and Quality (HAQ) index, gross domestic product (GDP), health care expenditures, access to cancer drugs, and patient empowerment has not been addressed before.

Material and methods: Epidemiologic data were obtained from the International Agency for Research on Cancer. The mortality-to-incidence ratio (expressed as 1-MIR) was used as proxy for 5-year survival. Information on health expenditure was obtained from Bloomberg Health-Care Efficacy ranking, the HAQ Index was used as a measure of available health care. For patient empowerment, visits to the Web site of the International Myeloma Foundation were used as proxy. Data on GDP and population per country were assessed from the International Monetary Fund and the United Nations Population Division, respectively. Possible associations were analyzed using Spearman's rank-order correlation.

Results: The worldwide incidence of MM is currently 160,000, and mortality is 106,000. Age-standardized myeloma incidence varies between 0.54 and 5.3 per 100,000 and correlates with 1-MIR, patient empowerment, HAQ Index, and access to cancer drugs. The 1-MIR varies between 9% and 64% and is closely related to myeloma incidence, HAQ Index, patient empowerment, access to cancer drugs, and health care expenditures.

Conclusion: The global incidence and outcome of MM shows significant disparities, indicating under-recognition and suboptimal treatment in many parts of the globe. Results also highlight the importance of economic resources, access to and quality of health care, and patient education for improving diagnosis and survival of patients with MM.

Implications for practice: Multiple myeloma accounts for 10% of all hematological malignancies and has moved to the forefront of clinical interest because of the significant advances in medical treatment. Diagnosis depends on laboratory tests, imaging, and professional expertise, particularly in patients without a significant M-component. The present data show a substantial worldwide variation in incidence and mortality, that is mainly due (apart from variations due to ethnicity and lifestyle) to disparities in access to and quality of health care, a parameter strongly related to the economic development of individual countries. Improvement of quality of care and, consequently, in outcome is associated with patient empowerment.

Keywords: Health care quality and access; Incidence; Mortality; Mortality-to-incidence ratio; Multiple myeloma; Patient empowerment.

Figure 1

Estimated age‐standardized incidence rates of multiple myeloma 2018. Used with permission of the International Agency for Research on Cancer/World Health Organization.

Figure 2

Incidence per 100,000 in relation to 1‐MIR (shown as percentage) (A), HAQ Index (B), visits to the IMF Web site per 100,000 (patient empowerment) (C), and access to cancer drugs (D). Abbreviations: MIR, mortality‐to‐incidence ratio; IMF, International Myeloma Foundation.

Figure 3

Relationship between mortality and incidence in countries with >1 million inhabitants (n = 150).

Figure 4

1‐MIR in countries with number of visits to the International Myeloma Foundation Web site available. Abbreviation: MIR, mortality‐to‐incidence ratio.

Figure 5

1‐MIR in relation to HAQ Index (A), health care spending (B), visits to the IMF Web site per 100,000 (patient empowerment) (C), and access to cancer drugs (D). Abbreviations: MIR, mortality‐to‐incidence ratio; HAQ, health care access and quality; IMF, International Myeloma Foundation.

Figure 6

Visits to the IMF Web site per 100,000 (patient empowerment) in relation to GDP (A), HAQ Index (B), health care expenditure (C), and access to cancer drugs (D). Abbreviations: GDP, gross domestic product; IMF, International Myeloma Foundation.