Rural and urban patients with diffuse large B-cell and follicular lymphoma experience reduced overall survival: a National Cancer DataBase study

• Type of Material: Article
• Authors: Andrew J. Ritter, Emory University; Jordan S. Goldstein, Emory University; Amy A. Ayers, Winship Cancer Institute; Christopher Flowers, Emory University
• Language: English
• Date: 2019-06-07
• Publisher: Taylor & Francis Ltd.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Informa UK Limited, trading as Taylor & Francis Group.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/10428194.2018.1546855
• Title of Journal or Parent Work: Leukemia & Lymphoma
• Volume: 60
• Issue: 7
• Start Page: 1656
• End Page: 1667
• Grant/Funding Information: Research reported in this publication was supported in part by National Cancer Institute award number K24CA208132 to Dr. Flowers.
• Keywords: overall survival; United States; Socioeconomic disparities; Disease characteristics; Positron-Emission Tomography; Oncology; Science & Technology; Hematology; Elderly patients; High risk; Life Sciences & Biomedicine; Diffuse large B-cell lymphoma; follicular lymphoma; rural; urban; Geographic access; health disparities; Adult Hodgkin lymphoma; Racial differences; Treatment patterns
• Research Categories: Health Sciences, Oncology; Sociology, Ethnic and Racial Studies; Health Sciences, Public Health; Biology, Cell

Abstract

We examined 83,108 patients with diffuse large B-cell lymphoma (DLBCL) and 43,393 patients with follicular lymphoma (FL) to investigate disparities related to geographic population density, stratified as rural, urban, or metropolitan. We found that urban and rural patients less commonly had private insurance and high socioeconomic status. Urban and rural DLBCL patients were more likely to receive treatment within 14 days of diagnosis (OR 0.93, 95% confidence interval [CI] 0.89–0.98; and OR 0.81, 95% CI 0.72–0.91) while urban FL patients were more likely to have treatment >14 days after diagnosis (OR 1.08, 95% CI 1.01–1.16). Multivariable analyses demonstrated that rural and urban patients had worse overall survival with DLBCL (hazard ratio [HR] 1.09; 95% CI 1–1.19 and HR 1.08; 95% CI 1.04–1.11) and FL (HR 1.11; 95% CI 1.04–1.18 and HR 1.2; 95% CI 1.02–1.41), respectively, suggesting needs for focused study and interventions for these populations.