Association of race/ethnicity and insurance with survival in patients with diffuse large B-cell lymphoma in a large real-world cohort

Objective: Few studies have evaluated disparities in race, ethnicity, and health insurance in real-world health outcomes for patients with diffuse large B-cell lymphoma (DLBCL). This study aimed to evaluate association between racial disparities and health insurance with real-world health outcomes. Methods: Patients with DLBCL (January 2011-July 2021) treated with first-line therapy were selected from a real-world database. Variables of interest included race/ethnicity, health insurance type (Medicaid, Commercial) by patient age (<65, >= 65 years), stage at diagnosis, overall survival (OS), and time to second-line therapy or death due to any cause (TTNTD). Results: Among 5362 patients with DLBCL (82% White, 7% Black, 8% Hispanic/Latino, 3% Asian), White patients were older (mean age, 66.7 vs. 59.3-62.5 years) and less likely to have Medicaid insurance (1.7% vs. 3.4%-5.9%). Adjusted hazard ratios (aHR) for OS (Black, 0.88 [95% confidence interval, 0.72-1.07]; Hispanic/Latino, 0.84 [0.70-1.03]; Asian, 0.82 [0.59-1.16]) and TTNTD (Black, 0.89 [0.75-1.05]; Hispanic/Latino, 0.85 [0.73-1.00]; Asian, 1.11 [0.86-1.43]) were similar to those of White patients. Among patients aged <65 years, Medicaid-insured versus Commercially insured patients had more advanced disease (stage III-IV, 66% vs. 48%), worse OS (aHR, 0.52 [0.34-0.80]; p = 0.003), and shorter TTNTD (aHR, 0.70 [0.49-0.99]; p = 0.044). Conclusions: There was no statistically significant difference in these variables/outcomes between Medicaid-insured and commercially insured patients aged >= 65 years. Medicaid-insured status was significantly associated with poorer OS and TTNTD in patients with DLBCL aged <65 years but not in those aged >= 65 years, with or without adjusting for other baseline characteristics. Race was not significantly associated with these outcomes.