The Impact of Socioeconomic Risk Factors on the Survival Outcomes of Patients With Newly Diagnosed Multiple Myeloma: A Cross-analysis of a Population-based Registry and a Tertiary Care Center

Abstract

Background: Multiple myeloma (MM) is a heterogeneous clonal plasma cell disorder leading to differences in clinical outcomes such as overall survival (OS) among patients. We hypothesized that with expensive, novel therapeutic agents and paradigm shifts to maintain continuous therapy and improvement in OS, patients with MM are subject to the pressures of financial toxicity and the need for social support, which may be of prognostic importance.

Materials and methods: In this study, we examined the records of 122,458 patients from the National Cancer Database (NCDB) to determine the significance of socioeconomic factors such as estimated annual household income and education level, which were based on the patient's ZIP Code and the United States Census Bureau's 5-year report from 2008 to 2012. These socioeconomic factors, in addition to marital status, were then assessed individually and as a cumulative socioeconomic score for prognostic significance in a cohort of 2543 patients treated at a tertiary care center utilizing known biologic risk factors, such as cytogenetic risk, International Staging System classification, and serum lactate dehydrogenase levels.

Results: Only marital status and estimated annual household income at diagnosis negatively impacted OS in a univariate analysis, but not in the context of a multivariable analysis incorporating known biologic risk factors.

Conclusion: Future analyses in other academic and non-academic centers located in urban and rural regions are required to understand the socioeconomic drivers of OS disparity among patients with MM observed nationally.

Keywords: Myeloma; Outcomes; Prognosis; Socioeconomic status; Survival.

Figure 1A:

Kaplan-Meier plot comparing OS between NDMM patients of 75 years of age or older and those under the age of 75 for the NCDB cohort. Figure 1B: Kaplan-Meier plot comparing OS between NDMM patients with a low median household income (<63,000 USD) and those with a high median household income from the NCDB cohort. Figure 1C: Kaplan-Meier plot comparing OS between NDMM patients with a high education level (<7% without a high school diploma) and those with a low education level from the NCDB cohort. Figure 1D: Kaplan-Meier plot comparing OS between NDMM patients with a high Charlson-Deyo Score (Scores 1–3) and a low Charlson-Deyo Score (Score 0) for the NCDB cohort.

Figure 2A:

Kaplan-Meier plot comparing OS between NDMM patients of 75 years of age or older and those under the age of 75 for the tertiary care center cohort. Figure 2B: Kaplan-Meier plot comparing OS between NDMM patients with and without social support (based on marital status) from the tertiary care center cohort. Figure 2C: Kaplan-Meier plot comparing OS between NDMM patients with a low median household income (<63,000 USD) and those with a high median household income from the tertiary care center cohort. Figure 2D: Kaplan-Meier plot comparing OS between NDMM patients with a high education level (<7% without a high school diploma) and those with a low education level from the tertiary care center cohort. Figure 2E: Kaplan-Meier plot comparing OS between NDMM patients based on time of diagnosis, representing diagnosis between 2005 and 2010 compared to 2011 to 2015. Figure 2F: Kaplan-Meier plot comparing OS between NDMM patients by FISH Risk Assessment, separated by Standard Risk or High Risk individuals for the tertiary care center cohort. Figure 2G: Kaplan-Meier plot comparing OS between NDMM patients based on ISS Classification, separated into Stage 1, Stage 2, or Stage 3 for the tertiary care center cohort. Figure 2H: Kaplan-Meier plot comparing OS between NDMM patients by LDH level, where patients with an LDH of greater than 222 U/L were considered to have an elevated LDH for the tertiary care center cohort.

Figure 3:

Kaplan-Meier plot comparing OS between NDMM patients by SES score, representing a difference in patients with a score of 0 vs. those with a score greater than 0 in the tertiary care center cohort.

Figure 4:

Kaplan-Meier plot comparing OS between NDMM patients by SES score, representing a difference in patients with a score of 0 vs. those with a score greater than 0 in the local county cohort.