Socioeconomic Status is Globally a Prognostic Factor for Overall Survival of Multiple Myeloma Patients: Synthesis of Studies and Review of the Literature

Abstract

Background: Socioeconomic status (SES) is reflecting differences in sociodemographic factors affecting cancer survivorship. Deprived, low SES populations have a higher prevalence of multiple myeloma and worst survival, a condition which widens over time.

Methods: We performed a meta-analysis of 16 studies (registries and cohorts) reporting myeloma patients' survival data according to SES. Ten studies reported Hazzard Ratio (H.R.) (95 % CI), and 16 studies reported p values. We combined the H.R. from 10 studies, and by using the Mosteller-Bush formula, we performed a synthesis of p values according to the area of the globe.

Results: Combination of H.R. from 10 studies including 85198 myeloma patients weighted to sample size of each study and adopting the hypothesis of random effect returned a combined H.R.: 1,26 (1,13-1,31) in favor of high SES patients.USA: Synthesis of p values coming from 6 studies (n=89807 pts) by using the Mosteller and Bush formula extracted a p-value of <0.0001 favoring high SES patients.Oceania: Synthesis of p values in two cohorts from Australia and New Zealand (n= 10196 pts) returned a p-value of 0,022 favoring high SES patients.Europe: The synthesis of p values from the U.K. and Greece studies (n=18533 pts) returned a p-value of <0,0001 favoring high SES patients.Asia: Synthesis of 2 studies from Asia (n=915 pts) returned a p-value of <0,0001 favoring high SES patients.

Conclusions: Across the globe and widening over decades, the socioeconomic status remains a gap for equality in myeloma care.

Keywords: Myeloma; Socioeconomic status.

Figure 1

Myeloma care according to ethnicity/race in East Macedonia and Thrace Greece. A) Disease characteristics and therapy with new anti-myeloma agents or autologous stem cell transplantation (ASCT) in Greeks and Greek Muslims. B) Progression Free Survival after first line treatment according to ethnicity/race (PFS1).

Figure 2

Studies flow diagram and final selection of studies included in this meta-analysis.

Figure 3

A) Meta-analysis and combination of Hazzard Ratio (H.R.) extracted from 10 studies reporting H.R. (95 % CI) for overall survival (O.S.) according to socioeconomic status (SES). B) Synthesis of p values from 16 studies reporting H.R. (95 % CI) for O.S. at 5 years according to SES segregating according to area of the globe that data are coming from. In each table percentage of 5y O.S. from all studies is reported and p values on the top denotes synthesis of p from all studies in this part of the world.