The role of race, socioeconomic status, and distance traveled on the outcome of African-American patients with multiple myeloma

Myeloma Research Program, Cleveland Clinic, Cleveland, Ohio, USA.
Haematologica (Impact Factor: 5.81). 11/2006; 91(10):1410-3.
Source: PubMed


The incidence and mortality of multiple myeloma (MM) in African-Americans is double that in whites. We questioned whether race, socioeconomic status, and distance traveled affect overall survival. In a retrospective review of the records of 292 patients with MM. We found that the median age was 60 years and 38 patients were African-Americans. The mean distance traveled was 67.7 miles. The median overall survival was similar in African-Americans and whites. Race, distance traveled and socioeconomic status were not independent prognostic factors for overall survival. In conclusion, socioeconomic status, distance traveled and race did not affect outcomes of MM patients treated at a specialized myeloma center.

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    • "This warrants a better understanding of factors that may influence disease course and outcomes across MM patient demographics. Previous population-based studies have shown variation in disease incidence and clinical behaviour among MM patients from different ethnic and geographical backgrounds (Savage et al, 1984; Abou-Jawde et al, 2006; Brown et al, 2008; Waxman et al, 2010). Current knowledge of ethnic disparities in MM suggests a higher incidence and better survival in African-American (AA) patients compared to Whites (Savage et al, 1984; Modiano et al, 1996; Verma et al, 2008; Kim et al, 2009). "
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    ABSTRACT: Studies of ethnic disparities in malignancies have revealed variation in clinical outcomes. In multiple myeloma (MM), previous literature has focused only on patients of Caucasian and African-American (AA) descent. We present a Surveillance Epidemiology and End Results (SEER)-based outcome analysis of MM patients from a broader range of ethnicities, representing current United States demographics. The SEER 17 Registry data was utilized to analyse adult MM patients diagnosed since 1992 (n = 37,963), as patients of other ethnicities were not well represented prior to that. Overall survival (OS) and myeloma-specific survival (MSS) were compared across different ethnicities stratified by year of diagnosis, registry identification, age, sex and marital-status. Hispanics had the youngest median age at diagnosis (65 years) and Whites had the oldest (71 years) (P < 0·001). Increased age at diagnosis was an independent predictor of decreased OS and MSS. Asians had the best median OS (2·7 years) and MSS (4·1 years), while Hispanics had the worst median OS (2·4 years). These trends were more pronounced in patients ≥ 75 years. Cumulative survival benefit over successive years was largest among Whites (1·3 years) and smallest among Asians (0·5 years). These disparities may be secondary to multifactorial causes that need to be explored and should be considered for optimal triaging of healthcare resources.
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    ABSTRACT: 1p.1411 Simultaneous analysis of correlated variables potentially over-controlled for the underlying mechanism and thus reduced the ability to observe sep- arate effects of race, SES, and distance traveled. It would have been more congruent with the study objectives to stratify by race and separately investigate SES or distance traveled. The authors also over-controlled for correlated clinical prognostic factors and omitted other important potential confounders. MM stage was defined by the Southwest Oncology Group (SWOG) staging system and incorporated into the model as a covariate along with β2 microglobulin (β2M) and albumin. 1p.1411 However, SWOG already incorporates β2M and albumin as part of its stag- ing criteria. 3 The results suggest over-controlling because stage, β2M, and albumin were not reported as predictors of MM survival, 1p.1411 despite ample evidence to the con- trary. 3-5 Furthermore, important prognostic factors such as C-reactive protein (CRP) were not addressed, despite evidence that concurrently elevated CRP and β2M are markers of poor prognosis in MM. 4 Elevated lactate dehydrogenase (LDH) is another important marker of poor survival for MM patients that was not incorporat- ed. 4 Inclusion of LDH could have partially accounted for lack of cytogenetic data.
    Full-text · Article · Apr 2007 · Haematologica
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