Social determinants of health and their impact on frontline treatment patterns among Medicare Advantage members with newly diagnosed multiple myeloma.

Abstract

Background: To improve health inequities, it is necessary to understand the impact of social determinants of health (SDoH), or social risk factors, including race and economic status, on multiple myeloma (MM) treatment patterns.

Objective: To identify SDoH factors leading to gaps in frontline treatment in Medicare beneficiaries with newly diagnosed MM (NDMM).

Methods: This retrospective study used data from various sources, including claims data, individual-level SDoH measures (eg, race, dual-eligibility [DE] status for Medicare and Medicaid, low-income subsidy [LIS] status, and special needs plan eligibility) from the Humana Research database population during the time frame from 2016 to 2023, and community-level SDoH measures from the Agency for Healthcare Research Quality database. Treatment pattern outcomes included treatment within 90 days of first MM diagnosis, time from diagnosis to frontline treatment, frontline treatment regimen type, daratumumab-containing frontline regimens, and duration of frontline therapy. Multivariable regression was used to evaluate the association between SDoH factors and MM treatment patterns.

Results: Of 4,483 individuals identified with NDMM, 31.9% were Black race and 24.1% had DE/LIS status. More than half of individuals in the study resided in areas that were above the national median for receiving public assistance, having less than high school education, having no health insurance, and having no Internet. In the overall cohort, 1,941 (43.3%) patients had no treatment within 12 months of diagnosis, 811 of whom had no evidence of symptomatic disease (ie, asymptomatic smoldering MM). Median time to treatment initiation (TTI) from diagnosis was 2.7 months, and 51.2% of patients received treatment within 90 days of diagnosis. Lower odds for treatment initiation within 90 days were observed for Black patients (vs White patients; odds ratio [OR] = 0.865 [CI = 0.752-0.995]), DE/LIS patients (vs non-DE/LIS; OR = 0.696 [CI = 0.599-0.809]), and by special needs plan enrollment (vs nonenrollment; OR = 0.717 [CI = 0.547-0.940]), but community-level SDoH was generally not independently associated with TTI. Among 2,523 patients who received frontline treatment within 12 months of diagnosis (treated cohort), TTI and duration of treatment were similar between the overall cohort and DE/LIS and non-White subgroups. Secular trends were observed in frontline treatment regimens, which were mostly triplets, and evolved over time to comprise fewer doublet regimens and more quadruplets, with an increase in daratumumab-based regimens.

Conclusions: Inequities in timely frontline NDMM treatment were observed for non-White patients and those with DE/LIS status. Combinations of community-level SDoH, but no one single factor, may underlie these inequities.