Abstract
The influence of socioeconomic status (SES) on access to standard chemotherapy and/or monoclonal antibody therapy, and associated secular trends, relative survival, and excess mortality, among diffuse large B-cell lymphoma (DLBCL) patients is not clear. We conducted a Hong Kong population-based cohort study and identified adult patients with histologically diagnosed DLBCL between 2000 and 2018. We examined the association of SES levels with the odds and the secular trends of receipt of chemotherapy and/or rituximab. Additionally, we estimated the long-term relative survival by SES utilizing Hong Kong life tables. Among 4017 patients with DLBCL, 2363 (58.8%) patients received both chemotherapy and rituximab and 740 (18.4%) patients received chemotherapy alone, while 1612 (40.1%) and 914 (22.8%) patients received no rituximab or chemotherapy, respectively. On multivariable analysis, low SES was associated with lesser use of chemotherapy (odd ratio [OR] 0.44; 95% CI 0.34–0.57) and rituximab (OR 0.41; 95% CI 0.32–0.52). The socioeconomic disparity for either treatment showed no secular trend of change. Additionally, patients with low SES showed increased excess mortality, with a hazard ratio of 2.34 (95% CI 1.67–3.28). Improving survival outcomes for patients with DLBCL requires provision of best available medical care and securing access to treatment regardless of patients’ SES.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) globally, constituting 25–40% of all cases in different geographic regions[1,2,3,4]
Data were retrieved from the Clinical Data Analysis and Reporting System (CDARS), which is a territory-wide electronic database operated by the Hospital Authority of Hong Kong
We detected an increasing survival gap between patients with high and low socioeconomic status (SES) over time. In this population-based study, we found evidence of disparity related to SES for access to cancer treatment amongst diffuse large B-cell lymphoma (DLBCL) patients in Hong-Kong
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) globally, constituting 25–40% of all cases in different geographic regions[1,2,3,4]. In a study using the National Cancer Database from the United States on patients with DLBCL, those with low SES were significantly less likely to have received chemotherapy or chemoimmunotherapy[7]. In another population-based study on patients with DLBCL from the Netherlands, which offers free access to health care, no disparities in treatment and survival were observed in patients with low SES8. Hong Kong has a healthcare system that offers both public and private medical care options, akin to that in countries such as United Kingdoms and S ingapore[9,10] It remains unclear whether optimal treatment is provided across socioeconomic groups. We aimed to determine the association between SES and access to therapy, its secular trend, as well as the long term DLBCL relative survival and excess mortality in a population-based study from Hong Kong
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
