Rural and urban patients with diffuse large B-cell and follicular lymphoma experience reduced overall survival: a National Cancer DataBase study

Abstract

We examined 83,108 patients with diffuse large B-cell lymphoma (DLBCL) and 43,393 patients with follicular lymphoma (FL) to investigate disparities related to geographic population density, stratified as rural, urban, or metropolitan. We found that urban and rural patients less commonly had private insurance and high socioeconomic status. Urban and rural DLBCL patients were more likely to receive treatment within 14 days of diagnosis (OR 0.93, 95% confidence interval [CI] 0.89–0.98; and OR 0.81, 95% CI 0.72–0.91) while urban FL patients were more likely to have treatment >14 days after diagnosis (OR 1.08, 95% CI 1.01–1.16). Multivariable analyses demonstrated that rural and urban patients had worse overall survival with DLBCL (hazard ratio [HR] 1.09; 95% CI 1–1.19 and HR 1.08; 95% CI 1.04–1.11) and FL (HR 1.11; 95% CI 1.04–1.18 and HR 1.2; 95% CI 1.02–1.41), respectively, suggesting needs for focused study and interventions for these populations.

Keywords:

• Diffuse large B-cell lymphoma
• follicular lymphoma
• rural
• urban
• overall survival
• health disparities

Acknowledgment

Research reported in this publication was supported in part by National Cancer Institute award number K24CA208132 to Dr. Flowers. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http://doi/10.1080/10428194.2018.1546855.