Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, OH, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Blood Cancer J. 2024 Aug 23;14(1):142. doi: 10.1038/s41408-024-01128-1.
This retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with multiple myeloma diagnosed between January 2017-December 2021. Electronic health records data captured time from diagnosis to initial prescription fill for oral antimyeloma medications and initiation of facility administered or oral antimyeloma treatment. We identified 720 patients with a mean age at diagnosis of 67 years ±11; 55% were male, 77% White, 22% Black, 1% other races, covered by private insurance (36%), traditional Medicare (29%), Medicare Advantage (25%), and Medicaid (8.3%). Over a third of patients (37%) resided in an area in the most disadvantaged area deprivation index (ADI) quartile. The median available follow-up was 765 days. Seventy-five percent of the cohort filled an oral antimyeloma medication prescription (excluding corticosteroids), with a median time to fill of 28 days (IQR, 15-61). In the multivariable Cox regression model, Black race (vs. White, adjusted hazard ratio [aHR], 0.61, 95% CI, 0.42-0.87), older age at diagnosis (aHR per 1 year, 0.97, 95% CI, 0.95-0.98), diagnosis during an inpatient admission (aHR, 0.63, 95% CI, 0.43-0.92), and estimated glomerular filtration rate ≤29 ml/min/1.73 m (vs. ≥60, aHR, 0.46, 95% CI, 0.29-0.73) were negatively associated with prescription fill for oral antimyeloma medication at 30 days, while insurance type and ADI were not significant predictors.
这项回顾性队列研究使用 Taussig 癌症中心的骨髓瘤患者登记处，确定了 2017 年 1 月至 2021 年 12 月期间被诊断为多发性骨髓瘤的成年患者。电子健康记录数据记录了从诊断到首次口服骨髓瘤药物处方和开始机构管理或口服骨髓瘤治疗的时间。我们确定了 720 名平均年龄为 67 岁的患者；55%为男性，77%为白人，22%为黑人，1%为其他种族，36%有私人保险，29%有传统医疗保险，25%有医疗保险优势，8.3%有医疗补助。超过三分之一的患者（37%）居住在最贫困地区剥夺指数（ADI）四分位数的地区。中位随访时间为 765 天。该队列中有 75%的患者（不包括皮质类固醇）开了口服骨髓瘤药物处方，中位数为 28 天（IQR，15-61）。在多变量 Cox 回归模型中，黑人种族（与白人相比，调整后的危险比[aHR]，0.61，95%置信区间[CI]，0.42-0.87）、诊断时年龄较大（aHR 每年增加 1 岁，0.97，95%CI，0.95-0.98）、住院期间诊断（aHR，0.63，95%CI，0.43-0.92）和估计肾小球滤过率≤29ml/min/1.73m（与≥60 相比，aHR，0.46，95%CI，0.29-0.73）与 30 天内口服骨髓瘤药物处方呈负相关，而保险类型和 ADI 不是显著的预测因素。
