Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Abstract

Objectives To assess whether socioeconomic indices such as income and educational level can explain part of the variation in survival among patients with myelodysplastic syndromes, and further to assess whether these factors influence care and treatment decisions. Methods Population‐based cohort study on 2945 Swedish patients diagnosed between 2009 and 2018 and included in the Swedish MDS Register. Relative mortality was assessed by Cox regression, whereas treatment differences were assessed by Poisson regression. Regarding mortality, patients were also compared to a matched comparison group from the general population. Results Mortality was 50% higher among patients in the lowest income category compared to the highest and 40% higher in patients with mandatory school education only compared to those with college or university education. Treatment with hypomethylating agents and allogeneic stem cell transplantation, as well as investigation with cytogenetic diagnostics were also linked to income and education. The findings were not explained by differences in risk class or comorbidity at the time of diagnosis. Conclusions Income and education are linked to survival among patients with myelodysplastic syndromes. Socioeconomic status also seems to influence treatment intensity as patients with less income and education to a lesser degree receive hypomethylating agents and transplants.

Socioeconomic position and clinical outcomes in patients with myelodysplastic syndromes: A population‐based cohort study

“…[31][32][33][34] Our findings on the association between SEP and mortality are in line with two prior studies. 11,12 A Swedish study n = 2945, using individual-level information on education, income and cohabitation status, found that the risk of death was 50% higher in the lowest income quintile compared to the highest (HR = 1.5, 95% CI: 1.3-1.8) and 40% higher among patients with a short education compared to patients with a long education (HR = 1.4, 95% CI: 1.2-1.6). 11 An older 'Surveillance Epidemiology and End Results' (SEER) based US study n = 2118, using neighborhood socioeconomic status as a measure of SEP, reported that patients from low SEP neighbourhoods had increased risk of death compared to patients residing in high-SES neighbourhoods (HR = 1.17, 95% CI: 1.02-1.34).…”

“…Our findings on the association between SEP and mortality are in line with two prior studies 11,12 . A Swedish study n = 2945, using individual‐level information on education, income and cohabitation status, found that the risk of death was 50% higher in the lowest income quintile compared to the highest (HR = 1.5, 95% CI: 1.3–1.8) and 40% higher among patients with a short education compared to patients with a long education (HR = 1.4, 95% CI: 1.2–1.6) 11 .…”

“…It is recognized that low socioeconomic position (SEP) is associated with adverse outcomes among patients with cancer, 3–8 but most literature to date has focused on patients with solid tumors, 3,4,7 lymphoma, 5,9 or acute myeloid leukemia (AML) 6,10 . Few studies examined the prognostic impact of SEP among patients with MDS 11–14 . Importantly, existing studies yielded conflicting results, 11–14 and were limited by insufficient sample size, 13,14 inclusion of patients >66 years only, 12 and were based on single‐center data 13,14 .…”

“…Few studies examined the prognostic impact of SEP among patients with MDS 11–14 . Importantly, existing studies yielded conflicting results, 11–14 and were limited by insufficient sample size, 13,14 inclusion of patients >66 years only, 12 and were based on single‐center data 13,14 . Further, studies lacked detailed and valid measures of SEP 12–14 .…”

“… 6 , 10 Few studies examined the prognostic impact of SEP among patients with MDS. 11 , 12 , 13 , 14 Importantly, existing studies yielded conflicting results, 11 , 12 , 13 , 14 and were limited by insufficient sample size, 13 , 14 inclusion of patients >66 years only, 12 and were based on single‐center data. 13 , 14 Further, studies lacked detailed and valid measures of SEP. 12 , 13 , 14 In addition, disease severity at diagnosis and important clinical outcomes, for example, progression to AML and treatment with allogeneic hematopoietic stem cell transplantation (allo‐HSCT) were less studied.…”