Greteman Breanna B, Tomasson Michael H, Kahl Amanda R, Wahlen Madison M, Bates Melissa L, Strouse Christopher, Charlton Mary E
Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Dr., S453 CPHB, Iowa City, IA, 52242, USA.
University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, 52242, USA.
Cancer Causes Control. 2025 Apr;36(4):433-442. doi: 10.1007/s10552-024-01938-5. Epub 2024 Nov 26.
It is important to understand racial inequities in multiple myeloma treatment and survival, particularly in the Midwest where clear differences exist in cancer incidence and mortality. Since age and geographic location can greatly impact treatment and prognosis, matching patients on these characteristics can help identify reasons for outcome differences.
Retrospective data from the Iowa Cancer Registry's Surveillance, Epidemiology, and End Results database were analyzed for adult patients diagnosed with first primary MM between 1/1/2010-12/31/2019. Matching procedures matched up to 4 White patients with each Black patient on age and city of residence. Demographic characteristics were compared, and Cox proportional hazards models were built to compare survival.
There were 1,845 patients in our overall sample, of which 85 were Black and 1,760 were White. There were 321 patients (74 Black, 247 White) that were matched. Black patients in the overall sample had decreased hazard for MM-specific death compared to White (HR = 0.50, 95% CI (0.43, 0.78)) when controlling for covariates. The decrease in MM-specific death in black patients was not statistically significant compared to matched controls (HR = 0.72, 95% CI (0.41, 1.27)). Treatment differences were not observed for either sample.
We found that, despite large racial differences in MM incidence and mortality in Iowa, there are no survival differences when matched on age and city of residence. These data fail to detect large barriers to myeloma treatment in Iowa, and are useful for formulating potential screening and prevention strategies. Future research should also assess results in different geographic areas, investigate survival among older White patients in rural areas, and investigate other potential reasons for mortality differences between Black and White MM patients such as specific treatments received.
了解多发性骨髓瘤治疗和生存方面的种族不平等现象很重要，尤其是在中西部地区，那里癌症发病率和死亡率存在明显差异。由于年龄和地理位置会极大地影响治疗和预后，根据这些特征对患者进行匹配有助于找出结果差异的原因。
对爱荷华癌症登记处监测、流行病学和最终结果数据库中的回顾性数据进行分析，研究对象为2010年1月1日至2019年12月31日期间被诊断为原发性多发性骨髓瘤的成年患者。匹配程序为每例黑人患者匹配至多4例年龄和居住城市相同的白人患者。比较人口统计学特征，并建立Cox比例风险模型比较生存率。
我们的总体样本中有1845例患者，其中85例为黑人，1760例为白人。有321例患者（74例黑人，247例白人）进行了匹配。在控制协变量时，总体样本中的黑人患者与白人相比，多发性骨髓瘤特异性死亡风险降低（风险比=0.50，95%置信区间（0.43，0.78））。与匹配的对照组相比，黑人患者多发性骨髓瘤特异性死亡的降低无统计学意义（风险比=0.72，95%置信区间（0.41，1.27））。两个样本均未观察到治疗差异。
我们发现，尽管爱荷华州多发性骨髓瘤的发病率和死亡率存在巨大的种族差异，但在年龄和居住城市匹配后，生存率没有差异。这些数据未能发现爱荷华州骨髓瘤治疗的重大障碍，有助于制定潜在的筛查和预防策略。未来的研究还应评估不同地理区域的结果，调查农村地区老年白人患者的生存率，并调查黑人和白人多发性骨髓瘤患者死亡率差异的其他潜在原因，如接受的特定治疗。
