Smith Matthew James, Belot Aurélien, Quartagno Matteo, Luque Fernandez Miguel Angel, Bonaventure Audrey, Gachau Susan, Benitez Majano Sara, Rachet Bernard, Njagi Edmund Njeru
Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London WC1V 6LJ, UK.
Cancers (Basel). 2021 Nov 19;13(22):5805. doi: 10.3390/cancers13225805.
(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.
(1) 背景：淋巴瘤患者生存的社会经济不平等现象持续存在，这可能由患者的合并症来解释。我们旨在评估合并症与在英格兰被诊断为弥漫性大B细胞淋巴瘤（DLBCL）或滤泡性淋巴瘤（FL）患者生存之间的关联，并考虑其他社会人口学特征。(2) 方法：基于人群的癌症登记数据与医院事件统计数据相链接。我们使用灵活的多水平超额风险模型，通过患者的合并症状态来估计超额死亡率和净生存率，并对社会人口学、经济和医疗因素进行调整，同时考虑患者的居住地区。我们对缺失数据采用潜在正态联合建模多重插补方法。(3) 结果：总体而言，2005年至2013年间，英格兰分别有15516例和29898例患者被诊断为FL和DLBCL。在DLBCL和FL患者中，与最不贫困地区的患者相比，在合并症状态、诊断时年龄、性别、种族和诊断途径调整后，最贫困地区的患者超额死亡风险分别高出1.22倍（95%置信区间（CI）：1.18 - 1.27）和1.45倍（95% CI：1.30 - 1.62）。(4) 结论：在调整合并症/多种合并症后，贫困与被诊断为DLBCL或FL患者的较差生存始终相关。在规划针对英格兰血液系统恶性肿瘤的公共卫生干预措施时，需要考虑合并症和多种合并症。
