Outcome Inequalities in Multiple Myeloma Patients in England: Incidence and Survival Rates Stratified by Ethnicity and Index of Multiple Deprivation

OBJECTIVES: The Index of Multiple Deprivation (IMD) summarizes relative deprivation across small geographic areas in the UK, incorporating domains including health, education and living environment. We compared incidence and survival rates of a cohort of multiple myeloma (MM) patients to national estimates and assessed whether survival varied with ethnicity and IMD.

METHODS: The number of MM cases and overall survival (OS) rates for the period 2013-22 were calculated from the UK Arcturis dataset, and compared to national cancer registration data from Public Health England, and Hematological Malignancies Research Network (HMRN) data, to assess their generalizability. Results were also stratified by ethnicity and IMD quintile. Survival curves were generated and Cox proportional-hazards models were fitted, adjusted for age, sex, ethnicity and IMD.

RESULTS: 3,878 MM patients diagnosed between 2013-2022 were identified in the UK Arcturis dataset, representing ~8% of MM patients nationally. Age and sex distributions were comparable across all data sources, as were age- and sex-stratified survival rates. In adjusted analysis, IMD was not associated with OS (hazard ratio [HR] 1.00, 95% CI 0.98-1.03). Median age at diagnosis increased with IMD, from 64 years in the most deprived quintile to 69 in the least deprived. OS was lower for people of Asian ethnicity compared to white (HR 1.91, 95% CI 1.19-3.06), despite typically being younger at diagnosis (median age 65 vs 69); OS amongst all other ethnicities was not significantly different.

CONCLUSIONS: OS varied with ethnicity but not IMD, suggesting that MM patients receive a similar standard of care irrespective of local deprivation. Despite this, we identified adjusted OS differences amongst ethnicity groups. The cause of lower survival in patients of Asian ethnicity, despite diagnosis at younger ages, is unclear and requires further investigation. Comparison to external estimates of MM survival rates suggests that these results are generalizable across the UK.