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Influence of Socioeconomic and Demographic Factors on Myelofibrosis Outcomes
Addressing socioeconomic disparities may improve survival for patients with myelofibrosis (MF), according to a study published in Annals of Hematology.
Although demographic characteristics and social determinants of health (SDOH) have been widely studied in various cancers, these factors remain underresearched in MF, a rare form of blood cancer. This study aimed to bridge that gap by retrospectively reviewing data of biopsy-proven patients with MF from the Surveillance, Epidemiology and End Results (SEER) database and Montefiore Medical Center (MMC), an underserved inner-city hospital.
The SEER data included 5403 patients with MF who were primarily non-Hispanic (NH) White with a median age of 69, spanning 2000 to 2021. The 2- and 5-year survival rates for this data set were 69% and 42%, respectively, with worse survival associated with older age, male sex, and diagnosis before 2011, the year the first-line therapy ruxolitinib was approved. In this cohort, NH-Black, unmarried, and lower-income patients had worse overall survival rates.
The MMC hospital data included 84 patients with MF, of whom 37% were NH-White and 28.5% NH-Black, and the median age was 66, spanning from 2000 to 2023. For this single-center analysis, 2- and 5-year overall survival rates were 90% and 61% respectively. NH-Black patients exhibited the lowest median survival; however, the difference was not statistically significant. In addition to having the poorest median survival, NH-Black patients tended to carry a higher proportion of high-molecular-risk (HMR) mutations, with a higher incidence in females, present at a younger age, and present with a higher Dynamic Internation Prognostic Scoring System (DIPSS) score. These patients also resided in areas with high vulnerability, measured by the Social Vulnerability Index, indicating significant socioeconomic stress. The majority of patients were diagnosed after the approval of ruxolitinib in 2011, which may explain improved survival.
Overall, comparing the data from SEER and MMC led researchers to conclude that the lack of cause-specific survival association for NH-Black patients suggests that their poorer overall survival outcomes are more likely linked to social factors, rather than biologic factors. These findings imply that addressing socioeconomic disparities may improve survival for patients with MF; however, further studies are needed.
“In conclusion, our study highlights the complex interplay between demographic and socioeconomic factors in influencing survival outcomes in MF and contributes to the ongoing conversation about equity in healthcare outcomes,” the researchers concluded. “Future research should aim to validate these findings in larger, more diverse cohorts and explore the underlying mechanisms driving survival discrepancies that exist for non-disease related factors.
Reference
Yan J, Hammami MB, Wei JX, et al. Socio-demographic determinants of myelofibrosis outcomes in an underserved center and the SEER national database. Ann Hematol. 2024;103(9):3543-3551. doi:10.1007/s00277-024-05894-7
