Excess Mortality by Multimorbidity, Socioeconomic, and Healthcare Factors, amongst Patients Diagnosed with Diffuse Large B-Cell or Follicular Lymphoma in England

Abstract

Simple Summary: Diffuse large B-cell (DLBCL) and follicular lymphoma (FL) account for most non-Hodgkin lymphoma diagnoses: around 35% and 20% in England, respectively. Despite the vast contrast in survival between the subtypes, similar socioeconomic inequalities in survival have persisted over the past two decades, possibly due to the presence of comorbidities. The aim of our study was to assess the association between socioeconomic status and survival from DLBCL or FL accounting for patient and health system characteristics. We found that, for both DLBCL and FL, the most deprived patients had a higher excess mortality hazard compared to the least deprived, regardless of the comorbidity status. Our results show the need for the current framework of the National Health Service to improve the survival of DLBCL and FL patients in the most deprived areas of England, and further consideration is needed for patient-tailored management plans amongst patients with comorbidities or multimorbidities.(1) Background: Socioeconomic inequalities of survival in patients with lymphoma persist, which may be explained by patients' comorbidities. We aimed to assess the association between comorbidities and the survival of patients diagnosed with diffuse large B-cell (DLBCL) or follicular lymphoma (FL) in England accounting for other socio-demographic characteristics. (2) Methods: Population-based cancer registry data were linked to Hospital Episode Statistics. We used a flexible multilevel excess hazard model to estimate excess mortality and net survival by patient's comorbidity status, adjusted for sociodemographic, economic, and healthcare factors, and accounting for the patient's area of residence. We used the latent normal joint modelling multiple imputation approach for missing data. (3) Results: Overall, 15,516 and 29,898 patients were diagnosed with FL and DLBCL in England between 2005 and 2013, respectively. Amongst DLBCL and FL patients, respectively, those in the most deprived areas showed 1.22 (95% confidence interval (CI): 1.18-1.27) and 1.45 (95% CI: 1.30-1.62) times higher excess mortality hazard compared to those in the least deprived areas, adjusted for comorbidity status, age at diagnosis, sex, ethnicity, and route to diagnosis. (4) Conclusions: Deprivation is consistently associated with poorer survival among patients diagnosed with DLBCL or FL, after adjusting for co/multimorbidities. Comorbidities and multimorbidities need to be considered when planning public health interventions targeting haematological malignancies in England.