What Nurses Should Know About How Socioeconomic Status, Health Care Resources Affect Survival in Black Patients With Myeloma

Nurses should be aware of several factors related to socioeconomic status and health care resource availability that influence overall survival (OS) in Black patients with newly diagnosed multiple myeloma (MM), as these factors “may drive disparities in care,” according to a recent study.

The retrospective study, presented at the 2024 American Society of Clinical Oncology Annual Meeting, evaluated if socioeconomic status and health care resource availability impacted OS in older patients with newly diagnosed MM based on race.

The researchers used linked Surveillance, Epidemiology, and End Results Program-Medicare claims and area health resource files to identify 6609 non-Hispanic White and non-Hispanic Black patients aged ≥66 years with newly diagnosed MM. The area health resource files included data on county-level health care resource availability, such as the number of long-term hospital beds and medical doctors.

Continuous Medicare A and B enrollment until the end of 2019 or preceding death was required. The researchers excluded patients who had other cancers, diagnosis from death data, missing county information, or had enrollment in health maintenance organizations or clinical trials. The study included age, sex, race, Charlson Comorbidity Index (CCI), poverty, education, and health care resource availability in the adjusted mixed effects Cox model.

Demographic Differences Between Black, White Patients With Newly Diagnosed MM

Among the 6609 patients with newly diagnosed MM, 15.6% were Black. Black patients tended to be younger, female, and have a higher CCI than White patients. The median age at diagnosis was 76 years in Black patients and 77 years in White patients (P<.001). Among Black patients, 57.1% were female, significantly higher than the 46.0% of White patients who were female (P<.001). The mean CCI was also significantly higher in Black patients (2.1) than in White patients (1.4; P<.001).

Within Census tracts, the mean percentage of patients living under the poverty line was 21.2% in Black patients, significantly higher than the rate of 11.3% in White patients (P<.001). There was also a significant difference in the mean percentage of patients who received <12 years of education, with a rate of 19.0% in Black patients compared with a rate of 11.3% in White patients (P<.001).

The unadjusted median OS was 2.76 years in Black patients and 3.01 years in White patients (hazard ratio [HR], 1.08; P=.063). The adjusted model showed that several socioeconomic status and health care resource availability factors were significant.

In addition, the OS hazard ratio by race reversed directionality when adjusted for demographics, socioeconomic status, and health care resource availability, but this was not significant (HR, 0.92; P=.12).

The authors concluded by providing an overview of the study findings, explaining that Black patients with newly diagnosed MM tended to be younger, have higher CCI, have completed less education, and were more likely to live in Census tracts with higher poverty rates than White patients.

“Several factors relating to [socioeconomic status] and [health care resource] availability significantly influenced OS and may drive disparities in care,” the study investigators explained. “Further research on larger datasets is needed to better understand these disparities.”

Reference

Li SS, Schuldt R, Zafar F, et al. Effects of socioeconomic status (SES) and healthcare resource (HCR) availability on survival in Black patients (pts) versus (vs) White pts with multiple myeloma (MM): a SEER Medicare analysis. Presented at the 2024 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2024, Chicago, Illinois.