We assessed differences in survival between non-Hispanic black (NHB) and non-Hispanic white (NHW) patients with multiple myeloma (MM), and the sequential effects of patient characteristics, and diagnosis and treatment-related factors on the survival disparity using data from 3319 NHB and 20,831 NHW MM patients in the SEER-Medicare (1999–2017) database. Four sets of 3319 NHWs were matched sequentially to the same set of 3319 NHBs, based on demographics (age, sex, year of diagnosis, marital status, and SEER site), socioeconomic status (SES, demographics plus SES), presentation factors (SES variables plus comorbidity), and treatment factors (presentation variables plus antimyeloma therapies). We found NHBs were less likely to receive treatment than NHWs even among patients matched for demographics, SES, and comorbidities. The absolute difference in 5-year survival between NHBs and NHWs was not significant in the demographics match (0.6%; P = 0.30) and remained non-significant after matching for SES (1.4%, P = 0.17). When matching for presentation, NHBs had significantly longer 5-year survival than NHWs (absolute difference = 3.8%, P = 0.003). Additional matching on treatment-related factors further enlarged the racial difference in 5-year survival to 4.6% (P < 0.001). Our findings reinforce the importance of equitable access to effective treatment modalities to further improve the survival of NHB patients with MM.
我们利用SEER-Medicare（1999-2017）数据库中3319名非西班牙裔黑人和20,831名非西班牙裔白人多发性骨髓瘤患者的数据，评估了两组患者的生存差异，并分析了患者特征、诊断及治疗相关因素对生存差异的连续影响。基于人口统计学特征（年龄、性别、诊断年份、婚姻状况和SEER地区）、社会经济地位（在人口统计学基础上加入社会经济因素）、临床表现因素（在社会经济变量基础上加入合并症）以及治疗因素（在临床表现变量基础上加入抗骨髓瘤治疗），我们依次将四组各3319名非西班牙裔白人与同一组3319名非西班牙裔黑人进行匹配。研究发现，即使在人口统计学特征、社会经济地位和合并症均匹配的患者中，非西班牙裔黑人接受治疗的可能性仍低于非西班牙裔白人。在人口统计学匹配中，非西班牙裔黑人与非西班牙裔白人的5年生存率绝对差异不显著（0.6%；P=0.30），且在社会经济地位匹配后仍无显著性（1.4%，P=0.17）。而在临床表现匹配时，非西班牙裔黑人的5年生存率显著长于非西班牙裔白人（绝对差异=3.8%，P=0.003）。进一步匹配治疗相关因素后，5年生存率的种族差异进一步扩大至4.6%（P<0.001）。我们的研究结果强调了公平获得有效治疗方式对进一步提升非西班牙裔黑人多发性骨髓瘤患者生存率的重要性。
肿瘤(癌症)患者之家