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Income and education affect prognosis and treatment in symptomatic myeloma : A population-based study on 8672 multiple myeloma patients diagnosed 2008–2021 from the Swedish myeloma registry

Larfors, Gunnar ; Carlson, Kristina ; Day, Christopher ; Einarsdottir, Sigrun ; Juliusson, Gunnar LU ; Karma, Moshtaak ; Knut-Bojanowska, Dorota ; Sverrisdóttir, Ingigerður Sólveig ; Turesson, Ingemar LU and Villegas-Scivetti, Mariana , et al. (2025) In Annals of Hematology 104(1). p.565-572
Abstract

Despite advancements in multiple myeloma treatment, prognostic variability persists. We investigated the impact of income and education on treatment and survival in a country with publicly funded healthcare. We analysed data from the Swedish Myeloma Registry (2008–2021) linked to national registers. Cox models assessed survival, adjusting for demographics and comorbidities. Treatment patterns were compared using cumulative incidence functions. Among 8,672 patients, higher education and income correlated with prolonged survival. Adjusted hazard ratios (HRs) for low income were 1.4 (95% CI 1.3–1.5) and for low education were 1.3 (95% CI 1.2–1.4). Higher income patients were more likely to receive lenalidomide (HR 1.5, 95% CI 1.3–1.6) and... (More)

Despite advancements in multiple myeloma treatment, prognostic variability persists. We investigated the impact of income and education on treatment and survival in a country with publicly funded healthcare. We analysed data from the Swedish Myeloma Registry (2008–2021) linked to national registers. Cox models assessed survival, adjusting for demographics and comorbidities. Treatment patterns were compared using cumulative incidence functions. Among 8,672 patients, higher education and income correlated with prolonged survival. Adjusted hazard ratios (HRs) for low income were 1.4 (95% CI 1.3–1.5) and for low education were 1.3 (95% CI 1.2–1.4). Higher income patients were more likely to receive lenalidomide (HR 1.5, 95% CI 1.3–1.6) and pomalidomide (HR 1.7, 95% CI 1.4-2.0), and less likely to receive melphalan tablets (HR 0.8, 95% CI 0.7–0.9). Low-income patients were less likely to undergo stem cell transplant (HR 0.8, 95% CI 0.7–0.9). Immigrant status or biological sex did not influence outcomes. Even in a tax-funded system, socioeconomic disparities impact myeloma survival and treatment. Lower socioeconomic status correlates with inferior outcome and more conservative treatment. Attitudinal biases may contribute to these disparities. Better treatment for the less privileged patients could significantly improve myeloma survival, advocating for efforts to overcome the influence of socioeconomic status.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cohort studies, Epidemiology, Multiple myeloma, Socioeconomic factors, Survival
in
Annals of Hematology
volume
104
issue
1
pages
8 pages
publisher
Springer
external identifiers
  • scopus:85217237142
  • pmid:39849162
ISSN
0939-5555
DOI
10.1007/s00277-025-06214-3
language
English
LU publication?
yes
id
00cd135f-67d4-41ed-b23f-c79fd805199b
date added to LUP
2025-04-08 15:53:35
date last changed
2025-07-15 23:32:35
@article{00cd135f-67d4-41ed-b23f-c79fd805199b,
  abstract     = {{<p>Despite advancements in multiple myeloma treatment, prognostic variability persists. We investigated the impact of income and education on treatment and survival in a country with publicly funded healthcare. We analysed data from the Swedish Myeloma Registry (2008–2021) linked to national registers. Cox models assessed survival, adjusting for demographics and comorbidities. Treatment patterns were compared using cumulative incidence functions. Among 8,672 patients, higher education and income correlated with prolonged survival. Adjusted hazard ratios (HRs) for low income were 1.4 (95% CI 1.3–1.5) and for low education were 1.3 (95% CI 1.2–1.4). Higher income patients were more likely to receive lenalidomide (HR 1.5, 95% CI 1.3–1.6) and pomalidomide (HR 1.7, 95% CI 1.4-2.0), and less likely to receive melphalan tablets (HR 0.8, 95% CI 0.7–0.9). Low-income patients were less likely to undergo stem cell transplant (HR 0.8, 95% CI 0.7–0.9). Immigrant status or biological sex did not influence outcomes. Even in a tax-funded system, socioeconomic disparities impact myeloma survival and treatment. Lower socioeconomic status correlates with inferior outcome and more conservative treatment. Attitudinal biases may contribute to these disparities. Better treatment for the less privileged patients could significantly improve myeloma survival, advocating for efforts to overcome the influence of socioeconomic status.</p>}},
  author       = {{Larfors, Gunnar and Carlson, Kristina and Day, Christopher and Einarsdottir, Sigrun and Juliusson, Gunnar and Karma, Moshtaak and Knut-Bojanowska, Dorota and Sverrisdóttir, Ingigerður Sólveig and Turesson, Ingemar and Villegas-Scivetti, Mariana and Blimark, Cecilie Hveding}},
  issn         = {{0939-5555}},
  keywords     = {{Cohort studies; Epidemiology; Multiple myeloma; Socioeconomic factors; Survival}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{565--572}},
  publisher    = {{Springer}},
  series       = {{Annals of Hematology}},
  title        = {{Income and education affect prognosis and treatment in symptomatic myeloma : A population-based study on 8672 multiple myeloma patients diagnosed 2008–2021 from the Swedish myeloma registry}},
  url          = {{http://dx.doi.org/10.1007/s00277-025-06214-3}},
  doi          = {{10.1007/s00277-025-06214-3}},
  volume       = {{104}},
  year         = {{2025}},
}