Association between multimorbidity and socioeconomic deprivation on short-term mortality among patients with diffuse large B-cell or follicular lymphoma in England: a nationwide cohort study

Abstract

Objectives: We aimed to assess the association between multimorbidity and deprivation on short-term mortality among patients with diffuse large B-cell (DLBCL) and follicular lymphoma (FL) in England.

Setting: The association of multimorbidity and socioeconomic deprivation on survival among patients diagnosed with DLBCL and FL in England between 2005 and 2013. We linked the English population-based cancer registry with electronic health records databases and estimated adjusted mortality rate ratios by multimorbidity and deprivation status. Using flexible hazard-based regression models, we computed DLBCL and FL standardised mortality risk by deprivation and multimorbidity at 1 year.

Results: Overall, 41 422 patients aged 45-99 years were diagnosed with DLBCL or FL in England during 2005-2015. Most deprived patients with FL with multimorbidities had three times higher hazard of 1-year mortality (HR: 3.3, CI 2.48 to 4.28, p<0.001) than least deprived patients without comorbidity; among DLBCL, there was approximately twice the hazard (HR: 1.9, CI 1.70 to 2.07, p<0.001).

Conclusions: Multimorbidity, deprivation and their combination are strong and independent predictors of an increased short-term mortality risk among patients with DLBCL and FL in England. Public health measures targeting the reduction of multimorbidity among most deprived patients with DLBCL and FL are needed to reduce the short-term mortality gap.

Keywords: epidemiology; lymphoma; statistics & research methods.

Figure 1

Overlap plots for the density of predicted probabilities of comorbidity status among patients (n=41 422), aged 45–99, in England diagnosed with non-Hodgkin’s lymphoma during 2005–2013. Propensity score: relates to the predicted probability of having any comorbidity level as measured by a multinomial logistic regression model conditioning on the independent variables (ie, age at diagnosis, sex, deprivation level and ethnicity). DLBCL, diffuse large B-cell lymphoma.

Figure 2

Risk of short-term mortality for follicular lymphoma (FL) (n=14 043) and diffuse large B-cell lymphoma (DLBCL) (n=27 379) by comorbidity status and deprivation level in England between 2005 and 2015 (solid: Aalen-Nelson approach, dash: standardised to the empirical distribution of age, sex and ethnicity).