OBJECTIVES: Structural racism – including racial and economic segregation – may drive persistent inequities in multiple myeloma (MM) treatment and survival. Here we examined the association of the Index of Concentration at the Extremes (ICE) for area-level racialized economic segregation, and real-world overall survival (rwOS) among patients with MM.

METHODS: This retrospective study used the nationwide (US-based) Flatiron Health electronic health record-derived de-identified database, focusing on patients diagnosed with MM from January 2011 to October 2022. The ICE for racialized economic segregation is a measure quantifying differences between the most and least privileged groups in an area (high-income White vs low-income Black households). Using data from the American Community Survey, we constructed a census tract-level measure of ICE categorized as US population-weighted quintiles (ranging from most to least privileged areas). We estimated median rwOS using Kaplan-Meier methods and examined associations using Cox proportional hazard models adjusted for clinical factors (age, sex, ECOG performance status, ISS stage).

RESULTS: The cohort included 10,321 patients (median age:70; male:53%). Compared to patients from the most privileged areas (Q1), patients from the least privileged areas (Q5) were older (median age:71 vs. 68), disproportionately Black (55% vs 6.6%) or Latinx (16% vs 3.8%), and had worse performance status (ECOG ≥2: 21% vs 16%). Patients from the least privileged areas had shorter median rwOS (63.4 vs. 69.4 months) and greater risk of death (adjusted HR:1.15 [95% CI:1.04-1.26]) than patients from the most privileged areas.

CONCLUSIONS: Racialized economic segregation was associated with survival among patients with MM, where those in the least privileged areas are at increased risk of death. Given inequities in the burden of MM – where Black adults are twice as likely to develop MM than their White counterparts – efforts to reduce persistent cancer inequities should assess and address racialized economic segregation and other forms of structural racism.