Socioeconomic, Demographic, and Health Comorbidities Associated with Advanced Stage at Diagnosis of Diffuse Large B-Cell Lymphoma: An NCDB Analysis


Alexandra Taylor, BS1, Jillian Gallegos, BS1, Peter Silberstein, MD2, Victoria A. Vardell, MD3 1 Creighton University School of Medicine, Omaha, NE, USA 2 Department of Internal Medicine, Division of Hematology/Oncology, Creighton University Medical Center, Omaha, NE, USA 3 Department of Internal Medicine, University of Utah, Salt Lake City, UT


Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma in adults, accounting for 25% of cases. Estimated current 5-year survival of patients diagnosed with early stage DLBCL (ES-DLBCL), stage I or II, is 74%, in contrast to 57% for those diagnosed with late stage, or stage III or IV, DLBCL (LS-DLBCL). The objective of this study is to identify the socioeconomic, demographic, and comorbid health conditions associated with a late-stage diagnosis.


The National Cancer Database was used to identify patients diagnosed with DLBCL between 2004 and 2018. 225,781 patients were analyzed, with 101,932 ES-DLBCL patients and 123,849 LS-DLBCL patients. The stage of diagnosis was analyzed by patient race, sex, insurance type, Charlson-Deyo comorbidity score, level of education, income, geographic location, facility type, facility location, and HIV status. Diagnosis groups were analyzed with each variable through cross-classification, chi square analysis, and one-way ANOVA. Multivariate binary logistic regression was used to compare the risk of LS-DLBCL diagnosis by patient characteristics.


There was significant variability in socioeconomic, demographic, and comorbid medical conditions associated with later stage of diagnosis. Uninsured patients were more likely to be diagnosed at a late stage, with 56.9% diagnosed as LS-DLBCL compared to 51.3% of patients with private insurance, Odds Ratio (OR) 0.792 (95% Confidence Interval (CI) 0.737-0.851, p<0.001). Patients with one or more comorbidities (Charlson-Deyo score) were more likely to be diagnosed at late stage than patients with no comorbidities; 57.3% of patients with one comorbidity and 60.0% of patients with two or more comorbidities received a LS-DLBCL diagnosis compared to 53.3% of patients with no comorbidities, OR 1.123 (95% CI 1.087-1.160, p<.001) and OR 1.226 (95% CI 1.177-1.278), respectively. African Americans were more likely to be diagnosed at a late stage compared to Caucasians, with 60.2% of African Americans receiving a LS-DLBCL diagnosis compared to 54.6% of Caucasians, OR 1.238 (95% CI 1.178-1.300). HIV positive patients were more like to be diagnosed at late stage, with 64.9% receiving a LS-DLBCL diagnosis compared to 54.3% of HIV negative patients, OR 0.325 (95% CI 1.244-1.411, p<.001).


Factors associated with an increased likelihood of LS-DLBCL compared to ES-DLBCL include lack of insurance, one or more comorbidities, African American race, and HIV positive status at time of diagnosis. This data supports the need for targeted efforts to advance access to care and early diagnosis for traditionally underserved populations with DLBCL.



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