Disparities in Multiple Myeloma Treatment, Mortality Risk Observed Among Hispanic Americans

Hispanic Americans with multiple myeloma (MM) face disparities in treatment, clinical trial enrollment, and mortality risk, among other factors, which may be exacerbated by lower socioeconomic status (SES). Results were published in a systematic review published in Clinical Hematology International.

Characterized as the largest and fastest-growing minority group in the United States, individuals of Hispanic/Latino ethnicity currently account for 15% of the US population. Health disparities in MM have been indicated to disproportionately affect minorities, particularly Hispanic Americans. However, there remains limited data on health disparities experienced by Hispanic Americans.

“Disparities in MM care for Hispanics in the United States continue to persist despite recent advancements in MM therapy. This can be related to limited access to care and lower utilization of effective MM therapies,” said the study authors. “Characterization of health disparities encountered by Hispanic Americans with MM is necessary to identify gaps and inform future strategies to eliminate them.”

They searched the EMBASE, MEDLINE/PubMed, CINAHL, Scopus, and Web of Science databases for studies which reported on health disparities in Hispanic American patients with MM. Relevant studies that ​​compared incidence, treatment, and/or outcomes of Hispanic Americans with other ethnic groups through December 2021 were eligible for inclusion.

A total of 868 articles were identified, of which 22 original study articles were included in the systematic review. Articles were categorized based on topic, year of publication, and author. The number of publications was indicated to vary over time with the highest number of studies (32%) published in 2021.

A majority of the included studies (59%) reported worse outcomes for Hispanic Americans with MM compared with other ethnic groups. Several key findings from the systematic review included:

• Incidence of MM in Hispanics was shown to be higher with a median age at presentation 5 years younger than in non-Hispanic Whites
• Higher proportion of Hispanic Americans with MM were indicated to reside in lower SES zip codes and zip codes with low education levels
• Hispanic Americans were found to receive less MM maintenance therapy and less supportive therapies, such as bisphosphonates
• Longer time from MM diagnosis to novel therapy initiation was more prevalent in Hispanic Americans when compared to non-Hispanic Whites
• Enrollment in MM clinical trials was lower in Hispanic Americans

Furthermore, autologous stem cell transplantation (ASCT) use in Hispanic Americans was shown to be lower than non-Hispanic Whites. Despite the incremental use of ASCT from 2008 to 2014, Hispanic Americans had the lowest rates of ASCT when compared to all other ethnic groups.

Regarding mortality risk, the rate of in-hospital mortality was higher in Hispanic Americans when compared to other ethnic groups. Although Hispanic Americans reported earlier age of diagnosis, these populations were found to be at higher risk of death, which researchers said may be related to lower SES.

“Improvement in MM survival, in this treatment landscape era of improved therapy options, was least pronounced in Hispanic Americans,” they said. “There is an urgent need to implement systemic and structural solutions to current barriers precluding equitable access to care for Hispanic patients.”

In discussing potential solutions to address the health disparities observed among Hispanic patients with MM, researchers cited the need to diversify the medical workforce as there remains a lack of physicians of Hispanic ethnicity within hematology/oncology.

Reference

Anampa‑Guzmán A, Alam ST, Abuali I, Al Hadidi S. Health disparities experienced by Hispanic Americans with multiple myeloma: A systematic review. Clin Hematol Int. Published online December 31, 2022. doi:10.1007/s44228-022-00026-2