Racial Disparities in Intravenous Bisphosphonate Use Among Older Patients With Multiple Myeloma Enrolled in Medicare

Abstract

PURPOSE: Intravenous (IV) bisphosphonates reduce the risk of skeletal-related events in patients with multiple myeloma (MM). However, data describing racial differences in IV bisphosphonate utilization outside of clinical trial settings are limited. We evaluated population-level IV bisphosphonate initiation and discontinuation among patients of age ≥ 65 years with MM. METHODS: We conducted a retrospective cohort study of patients of age ≥ 65 years diagnosed with first primary MM between 2001 and 2011. Patients were identified using the SEER-Medicare linked database and followed through December 2013. Cumulative incidences of IV bisphosphonate initiation and time to discontinuation among users were compared between racial and ethnic groups. In Fine and Gray competing risk models, we estimated subdistribution hazard ratios (SHRs) and 95% CIs for initiation and discontinuation. RESULTS: We included 14,231 eligible patients with MM (median age, 76 years; 52% male). Over a median follow-up of 23.1 months, 54% of patients received at least one IV bisphosphonate dose. Our final analytical sample included 10,456 non-Hispanic (NH) Whites, 2,267 NH Blacks, 548 Asian and Pacific islanders, and 815 Hispanic and Latino patients. A higher proportion of White patients (56.1%) newly received IV bisphosphonates after MM diagnosis compared with NH Blacks (45.4%). Compared with White patients, NH Black patients were less likely to initiate IV bisphosphonates (SHR, 0.74; 95% CI, 0.70 to 0.79) and slightly more likely to discontinue treatment (SHR, 1.10; 95% CI, 1.01 to 1.19). CONCLUSION: Approximately half of the patients with MM of age ≥ 65 years did not receive IV bisphosphonates, with significant delay among racial minority groups. These findings highlight the need for improvement of IV bisphosphonate uptake in patients with MM of age ≥ 65 years.

Global disparities in patients with multiple myeloma: a rapid evidence assessment

“…Overall, 1696 articles were identified, and after the removal of duplicates and exclusion by level 1 (title and abstract) and level 2 (full text) screening, 84 articles were identified as meeting the inclusion criteria. Of these 84 articles, 48 were studies in the US [ 14 – 16 , 19 – 62 ], and 36 were studies outside the US (non-US) [ 63 – 97 ]. The full list of all 84 included studies is shown in Supplementary Table 2 .…”

“…For race/ethnicity and access to treatment, 19 US studies (Supplementary Table 5 ) and one study each in the United Kingdom and New Zealand were identified. Among the US studies, most reported worse access to treatment for Black [ 15 , 21 , 31 , 32 , 36 , 37 , 40 , 42 , 47 , 54 , 55 ], Asian [ 19 , 31 , 62 ], and Hispanic patients [ 15 , 22 , 31 , 55 ] compared with White patients. In the US studies, there were trends suggesting that Hispanic patients and Black patients were less likely than White patients to receive stem cell transplantation [ 20 , 22 , 31 , 32 , 37 , 40 , 55 ] and that Black patients were more likely to experience delay in receiving stem cell transplantation compared with White patients [ 26 ].…”

Determinants of Bone-Modifying Agent Prescribing for Metastatic Castration-Resistant Prostate Cancer in a National Health Care Delivery System

“…In addition, we observed lower BMA utilization in Black patients compared with White, similar to previously described racial disparities in bisphosphonate therapy use in patients with cancer. 20 Previous studies have reported BMA use rates of 61%-68% among patients with mCRPC. 21,22 The VA population disproportionately serves patients with more comorbidities and more patients who are Black, so it is possible these associations are driving our observation for decreased BMA use in our study (47%) compared with other cohorts, and not a function of the VA in general.…”

A scoping review of racial, ethnic, socioeconomic, and geographic disparities in the outcomes of older adults with cancer

“…After screening, 130 articles initially and 59 articles subsequently met the inclusion criteria for this review (Table 1). Most articles were retrospective analyses (n = 52), [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]34,[36][37][38][39][41][42][43][45][46][47][48][49][50]52,[55][56][57][58][59][60][61][62][63][64][66][67][68][69][70][71][73][74][75]…”