Race/Ethnicity and Socioeconomic Status Appear to Affect Survival Outcomes in Multiple Myeloma

Higher neighborhood socioeconomic status improves long-term survival in patients with multiple myeloma regardless of overlapping disparities between racial and ethnic groups.

Elevated neighborhood socioeconomic status (SES) improved long-term survival outcomes for patients with multiple myeloma; the effect was especially pronounced in White, Black, and Asian or Pacific Islander (API) patients, according to data from an analysis published in Cancer Causes & Control.1

Investigators found that White and Black adults living in low SES neighborhoods were 17% (95% CI, 1.12-1.22) and 14% (95% CI, 1.04-1.23) more likely to die from multiple myeloma than White and Black adults living in high SES neighborhoods, respectively. The difference in outcomes for API adults was even starker, with those living in low SES neighborhoods being 35% (95% CI = 1.16–1.57) more likely to die from multiple myeloma than those living in high SES neighborhoods. For Hispanic adults, the survival difference was not found to be statistically significant, with those living in low SES neighborhoods having a 9% (95% CI, 0.96-1.19) higher chance of death than those living in high SES neighborhoods.

“Racial/ethnic disparities in multiple myeloma survival are well documented; however, research on SES disparities has been less consistent,” the investigators wrote. “This study has several strengths, including evaluating both race/ethnicity and neighborhood SES together to better understand the patterning of disparities in multiple myeloma survival. Along these lines, our findings highlight the need for interventions to address disparities in both race/ethnicity and neighborhood SES related to multiple myeloma prognosis.”

The analysis examined 55,602 cases of multiple myeloma of 79,603 cases diagnosed from 2000 to 2015. Most of the evaluated adults were White (64%); the White (76%) and API (8%) patient populations was more likely to live in neighborhoods of high SES than low SES (46% vs 3%, respectively). A low proportion of Hispanic and Black patients, respectively, in high SES neighborhoods (7.0% and 8.0%) compared with low SES neighborhoods (17.5% and 32.0%). In total, 31% of adults evaluated lived in neighborhoods with low SES.

Overall, investigators found that 41% of patients with multiple myeloma living in high SES neighborhoods were still alive at the end of the study period compared with 34% of those living in low SES neighborhoods. Median follow-up was somewhat longer for patients in high SES neighborhoods at 3 years vs 2 years for patients in low SES neighborhoods. Investigators reported a statistically significant interaction between SES and race/ethnicity (P = .04).

While prior studies have produced conflicting results regarding the influence of SES on treatment outcomes, the investigators suggested this may be due in part to not taking certain factors into consideration. “Our findings suggest that these disparate findings may be due to the fact that [prior] studies did not consider how the association between SES and multiple myeloma survival differs across racial/ethnic groups,” investigators wrote. “In terms of multiple myeloma survivorship, an intersectional perspective suggests that the material and social resources that economic advantage confers differ in meaningful ways across racial/ethnic groups.”

This analysis highlighted the importance of moving in a direction beyond overly simplistic umbrella categories for racial and ethnic minorities and the need for precise demographic classification schemes in epidemiological research. Investigators concluded that future studies on this subject should account for differences in treatments and comorbidities between patients to further test the associations observed.

Reference

Castañeda-Avila MA, Jesdale BM, Beccia A, Bey GS, Epstein MM. Differences in survival among multiple myeloma patients in the United States SEER population by neighborhood socioeconomic status and race/ethnicity. Cancer Causes Control. 2021;32(9):1021-1028. doi:10.1007/s10552-021-01454-w