Racial disparities in health outcomes of patients with diffuse large B-cell lymphoma using real-world data

Abstract

Abstract Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. However, significant racial disparities have been reported in its diagnosis, treatment, and outcomes. This study aims to evaluate these disparities using real-world data. Methods: We conducted a retrospective cohort study using the TriNetX collaborative network, comparing Black and White adult patients (≥18 years) diagnosed with DLBCL between 2016 and 2020. Propensity score matching was performed for age, sex, and other comorbidities to reduce confounding. Each cohort included 2,590 patients. Outcomes included mortality, hospitalizations, emergency department (ED) and intensive care unit (ICU) visits, cardiac conditions, deep vein thrombosis (DVT), pulmonary embolism (PE), and respiratory infections. Kaplan-Meier survival analysis was also conducted. Results: Hospitalization was significantly higher among Black patients (50.6%) compared to White patients (44.1%) (RR 1.15, p = 0.001). Black patients also had higher ICU admission rates (16.8% vs. 14.0%; RR 1.20, p = 0.008). ED visits occurred in 25.6% of Black patients vs. 22.4% of White patients (RR 1.14, p = 0.024). No statistically significant difference was observed in 30-day mortality (21.1% vs. 19.1%; p = 0.066). However, Black patients had lower 5-year survival (log-rank p = 0.016), with a hazard ratio of 1.16 (95% CI: 1.03–1.31, p = 0.003). Higher rates of DVT (RR 1.23, p = 0.028) and PE (RR 1.44, p = 0.003) were reported among the black patients. Heart failure rates were also higher among Black patients (RR 1.33, p = 0.001). No statistically significant differences were found in coronary artery disease (p = 0.345) or respiratory tract infections (p = 0.053) in both populations. Conclusions: Despite advances in therapy, diffuse large B-cell lymphoma (DLBCL) continues to reflect racial differences in health outcomes. Our findings highlight these disparities and emphasize the need for targeted interventions to improve outcomes.