Patients With AL Amyloidosis From Lower Socioeconomic Status Report Lower Quality of Life

Patients with AL amyloidosis from lower socioeconomic status (SES) groups had poorer health-related quality of life (HRQoL) when compared to patients with more education and/or professional/managerial positions, according to an abstract being presented at the 59th Annual Meeting of the American Society of Hematology in Atlanta, Georgia.

“SES can affect HRQoL through a variety of mechanisms, including poor access to healthcare, physical and mental comorbidities, low levels of health literacy or health activation, and consequent negative health behaviors,” wrote the study authors.

The cross-sectional, observational study looked at 1289 patients with AL amyloidosis evaluated between 1994 and 2014 at the amyloidosis Center at Boston University. Participants completed the SF-36v1 Health Surveys, within 7 days of their initial evaluation, which assessed HRQoL in relation to 8 domains and 2 component measures:

• Physical functioning (PF)
• Role limitations due to physical health problems (RP)
• Bodily pain (BP)
• General health (GH)
• Vitality (VT)
• Social functioning (SF)
• Role limitation due to emotional health problems (RE)
• Mental health (MH)
• Physical (PCS) and mental component summaries (MCS)

Participant SES was determined based upon occupation type and educational attainment. Authors used regression models including each SF-36v1 domain or summary score as a dependent variable to determine if there was a link between SES and HRQoL. The association was determined independent of other characteristics such as type of organ involvement, multi-organ involvement, eligibility for stem cell transplantation, and time since diagnosis.

The models produced results showing patients with less years of education reporting worse HRQoL impairment compared to patients with more education. Differences by educational attainment (with the exception of GH, MH, and MCS) all exceeded a threshold of 1 minimally important difference (MID).

Using occupation at the independent variable for SES, scores also differed drastically by occupation. Patients in other (non-professional/managerial) occupations reported statistically (P < 0.05 for all) and clinically (exceeding 1 MID) substantial deficits on all SF-36v1 scores.

Patients on disability presented significantly worse SF-36v1 scores (P < 0.05 for all), and deficits exceeded 1 MID for all scores. For PF, VT, and PCS, the differences surpassed 2 MIDS. Patients who were retired conveyed significant deficits for PF and RP (P < 0.05 for both).

“Outreach efforts designed to increase the understanding of the disease among community-based clinicians should highlight the additional HRQoL burden and potential need for more comprehensive care among patients with SES groups,” concluded the authors.

The meeting takes place from December 9-12, 2017.