Income and outcome in myelodysplastic syndrome: The prognostic impact of SES in a single-payer system

England, James T.; Zhang, Liying; Buckstein, Rena; Lenis, Martha; Li, Claudia; Earle, Craig C.; Wells, Richard A.

doi:10.1016/j.leukres.2013.08.021

Cited by 3 publications

(14 citation statements)

References 21 publications

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“…When specific outcomes were studied, in contrast to the study by England et al, (2013), we were unable to demonstrate leukaemic-transformation as being more frequent in patients of higher SES. Since all MDS patients in Tayside are treated within NHS Tayside hospitals, the possibility of referral patterns introducing bias in 16 the Canadian study should be considered.…”

Section: Discussioncontrasting

confidence: 94%

“…In keeping with observations from other studies (Wang et al, 2009;England et al, 2013), no cytogenetic features or MDS risk scores are unique to patients within specific SES quintiles. Oncogenic gene mutations believed to drive the disease process in MDS also do not have an obvious association with SES when genes are grouped according to function: mutations in genes responsible for RNA splicing, regulation of the epigenome or transcription were equally represented in patients from different SES.…”

Section: Discussionsupporting

confidence: 85%

“…The predictors of survival we have identified in Cox-regression analyses are not new, but importantly, these validate our dataset and its suitability for models to investigate associations between SES and MDS. Thus, the comparable survival outcomes between patients from different SES in our study, combined with the observations from a Canadian cohort of patients (England et al, 2013) strongly indicate the ability of equitable healthcare access in MDS to negate adverse outcomes associated with socioeconomic deprivation (Wang et al, 2009). …”

Section: Discussionsupporting

confidence: 64%

“…For example, the lower incidence of childhood acute lymphoblastic leukaemia across levels of increasing relative deprivation could reflect under-diagnosis in lower socioeconomic communities (Kroll et al, 2012;Lightfoot et al, 2012), and the mortality in AML and myeloma appears to be reduced in higher SES groups in some studies (Kristinsson et al, 2009). In MDS, studies investigating the effects of SES on outcomes (Wang et al, 2009;England et al, 2013) have yielded conflicting conclusions, possibly due to differences in healthcare funding or organisational structure of healthcare services.…”

Section: Introductionmentioning

confidence: 99%

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Impact of socioeconomic status on disease phenotype, genomic landscape and outcomes in myelodysplastic syndromes

et al. 2016

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SummaryGenetic and epigenetic alterations contribute to the biological and clinical characteristics of myelodysplastic syndromes (MDS), but a role for socioeconomic environment remains unclear. Here, socioeconomic status (SES) for 283 MDS patients was estimated using the Scottish Index of Multiple Deprivation tool. Indices were assigned to quintile categorical indicators ranked from SES1 (lowest) to SES5 (highest). Clinicopathological features and outcomes between SES quintiles containing 15%, 20%, 19%, 30% and 16% of patients were compared. Prognostic scores identified lower-risk MDS in 82% of patients, with higher-risk disease in 18%.SES quintiles did not associate with age, gender, cytogenetics, IPSS, or in subanalysis (n=95), driver mutations. The odds ratio of a diagnosis of RA was greater than other MDS sub-types in SES5 (OR 1.9, p=0.024). Most patients (91%) exclusively received supportive care. SES did not associate with leukaemictransformation or the cause of death. Cox regression models confirmed male gender (p<0.05), disease-risk (p<0.0001) and age (p<0.01) as independent predictors of leukaemia-free survival, with leukaemic-transformation an additional determinant of overall survival (p=0.07). Thus, if access to healthcare is equitable, SES does not determine disease biology or survival in MDS patients receiving supportive treatment; whether outcomes following disease-modifying therapies are influenced by SES requires additional studies.

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Section: Discussioncontrasting

confidence: 94%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

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Impact of socioeconomic status on disease phenotype, genomic landscape and outcomes in myelodysplastic syndromes

et al. 2016

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“…A study based on SEER data from the United States found higher mortality in MDS patients from low‐ or medium‐income areas compared to high‐income areas 11 . However, smaller studies from Minnesota, 12 Maryland, 13 Ontario 14 and Scotland, 15 have failed to replicate this finding, and authors have suggested that the reported differences in the larger US study could derive from unequal access to primary care.…”

Section: Introductionmentioning

confidence: 99%

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

Larfors

Berggren

Garelius

et al. 2021

European J of Haematology

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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.

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

Lauritsen

Østgård

Grønbæk

et al. 2022

Hematological Oncology

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Low socioeconomic position (SEP) may be associated with adverse outcomes in patients with myelodysplastic syndromes (MDS) inherent to for example, delayed diagnosis or reduced treatment intensity, but firm evidence is limited. In this study, we examined the association between SEP and clinical outcomes. We conducted a population-based cohort study (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) of 2233 Danish patients with MDS.SEP measures included individual-level information on education, cohabitation status and income retrieved from Statistics Denmark. Associations between SEP measures and disease severity at diagnosis were examined using binomial regression analysis. Using time-to-event analysis, we examined the association between SEP measures and treatment with allogeneic stem cell transplantation (allo-HSCT), risk of progression to acute myeloid leukemia (AML), and death. Estimates were adjusted for covariates selected based on direct acyclic graphs and reported with 95% confidence intervals. Patients with a short education were more likely to be transfusion-dependent at diagnosis (RR = 1.25, 95% CI: 1.04-1.45) and more likely to be diagnosed with higher risk MDS according to the International Prognostic Scoring System (RR = 1.29, 95% CI: 1.03-1.62), than patients with a long education.We found no clear association between SEP and risk of progression to AML. In adjusted models, the 1-year risk of dying was higher in patients with short versus long education (RR = 1.34, 95% CI: 1.08-1.65), in patients with low versus high income (RR = 1.42, 95% CI: 1.14-1.77), and among patients who lived alone compared to those who lived with a partner (RR = 1.15, 0.98-1.35). These associations persisted after 3 years and 5 years of follow-up. Notably, patients with a short education had a markedly lower rate of undergoing treatment with allo-HSCT compared to patients with a long education (HR = 0.51, 95% CI: 0.31-0.84). In conclusion, low SEP and especially short education, were poor prognostic factors for adverse clinical outcomes among patients with MDS.

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Income and outcome in myelodysplastic syndrome: The prognostic impact of SES in a single-payer system

Cited by 3 publications

References 21 publications

Impact of socioeconomic status on disease phenotype, genomic landscape and outcomes in myelodysplastic syndromes

Impact of socioeconomic status on disease phenotype, genomic landscape and outcomes in myelodysplastic syndromes

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

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

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