Effects of Socioeconomic Status and Healthcare Resource Availability on Survival in Older (≥66 years) Non-Hispanic Black Patients Versus Non-Hispanic White Patients With Multiple Myeloma

Background

Several factors contribute to the known disparities in overall survival (OS) between non-Hispanic Black (NHB) patients and non-Hispanic White (NHW) patients with multiple myeloma (MM).

Patients and Methods

To explore whether socioeconomic status (SES) and healthcare resource (HCR) availability impacts OS, this retrospective study used linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims and Area Health Resource Files to identify NHB and NHW patients aged ≥66 years with MM (newly diagnosed 6/1/2013-12/31/2017). Continuous Medicare A and B enrollment until 12/31/2019 or preceding death was required.

Results

In total, 6,609 patients were identified; 15.6% were NHB. At baseline, NHB patients were younger, more likely to be female, had higher Charlson Comorbidity Index (CCI), and were more likely to live in census tracts with lower education attainment and higher poverty percentages than NHW patients.

Unadjusted median OS by race/ethnicity for NHB patients versus NHW patients was 2.76 versus 3.01 years (hazard ratio [HR]: 1.08; P = .063). In the adjusted model, older age at diagnosis (P < .001), male sex (P = .02), and higher CCI (P < .001) increased risk of death. Poverty (P = .02) and number of active medical doctors per 100,000 (P = .003) were significant but not clinically meaningful. OS HR by race reversed directionality when adjusted for demographics, SES and HCR availability (HR: 0.92; P = .12).

Conclusion

Several factors, including SES and HCR availability, significantly influenced OS and may drive disparities in care for patients with MM. Further research on larger datasets is needed.