Several studies presented during the 2022 American Society of Hematology (ASH) Annual Meeting and Exposition uncovered significant disparities in medical care and health outcomes among patients of different racial backgrounds, nationalities, and socioeconomic status across a range of blood disorders. The new findings underscored the importance of acting to close gaps in the health-care system and ensure care is delivered equitably.
“This work reinforces that many health outcomes are attached to the history of our nation and the social constructs that we deal with in the world,” said press briefing moderator Chancellor Donald, MD, of Tulane University School of Medicine, New Orleans. “We consistently find that there’s work to be done, and researchers should continue not only to assess whether disparities exist, but to find opportunities to correct any disparities that they find.”
Chancellor Donald, MD
Dr. Donald added that proactively working to address disparities can go a long way toward achieving better outcomes, even without new tests or therapies. For instance, one study found stark differences in the types of therapies used to treat pulmonary embolism in different groups along with disparities in associated death rates, suggesting an opportunity for clinicians to employ existing tools more effectively across all groups.1
A second study focused on the importance of diverse representation in clinical trials.2 Further studies highlighted inequities in the delivery of stem cell transplants in the United States and globally, pointing to opportunities to improve access to this potentially curative treatment. A virtual press briefing on these studies was held on December 7, 2022.
Disparities in Treatments and Outcomes for Pulmonary Embolism
Racial minorities and people with lower incomes or who are insured by Medicare or Medicaid are significantly less likely to receive the most advanced therapies and more likely to die after suffering a pulmonary embolism, according to a recent analysis.1 The study, based on data from more than 1 million patients in the United States, found that 6.4% of those hospitalized for pulmonary embolism died of the condition, a high case-fatality rate that further underscores the urgency of reducing disparities and improving access to care, according to researchers.
Mary Cushman, MD, MSc
Mary Cushman, MD, MSc, of the Larner College of Medicine at the University of Vermont, Burlington, presented this study during an oral presentation on December 10. “Many people die of pulmonary embolism every year. It’s preventable and it’s certainly treatable. We need to think about what we can do in hospitals to make sure that care is equitable,” Dr. Cushman said.
The investigators reported that among people with the most severe pulmonary embolism, Black, Hispanic, and Asian patients were significantly more likely to die than White patients. Among all racial groups, the overall rate of pulmonary embolism was lowest among Asian people, but Asian patients were 24% less likely to receive advanced therapies and 50% more likely to die compared with White patients. Black patients with high-risk pulmonary embolism were 13% less likely to receive advanced therapies compared with White patients and 11% more likely to die. Hispanic patients were 10% more likely to die than White patients. People insured by Medicare or Medicaid were around 30% less likely to receive advanced therapies than privately insured people, and people in the lowest quartile for income were 9% more likely to die than people in the highest quartile for income.
The researchers stated that urgent attention is needed to better understand how factors such as structural racism and socioeconomic constraints may affect a person’s access, ability, and willingness to seek care, as well as clinical decision-making once patients arrive at the hospital.
Eligibility Criteria by Race/Ethnicity in DLBCL
People with diffuse large B-cell lymphoma (DLBCL) were much less likely to be eligible to participate in clinical trials to test new front-line therapies for the disease if they were in a minority racial or ethnic group, according to a recent study.2 Even though the clinical trials examined in the study did not exclude patients based on race or ethnicity directly, the results showed that patients in minority groups were more likely to fall short of trial criteria based on levels of hemoglobin, neutrophil count, platelet count, creatinine, and bilirubin.
“Our research has shown that about a quarter of patients are being excluded from front-line trials based on these five criteria alone,” said Matthew Maurer, DMSc, of Mayo Clinic in Rochester, Minnesota, who presented the study during an oral presentation on December 12. “These are patients who want to participate in research [and] have the resources to go to an academic medical center, and yet these exclusion criteria are not impacting everyone equally—they’re impacting minorities more than White non-Hispanic patients.”
Matthew Maurer, DMSc
The study is based on data from the Lymphoma Epidemiology Outcomes (LEO) Cohort, an observational cohort study that prospectively enrolls and follows patients with lymphoma from eight large academic medical centers across the United States. Researchers analyzed health records from 2,185 patients in LEO to assess which patients would satisfy the eligibility criteria for eight recent DLBCL clinical trials. About 76% of those included in the sample were non-Hispanic White, and 24% were Hispanic and/or non-White.
Overall, the researchers found that 9% to 26% of patients with newly diagnosed DLBCL in the LEO Cohort would have been excluded from recent phase III clinical trials based on lab-based criteria alone. These lab values varied significantly by race and ethnicity. As a result, Hispanic and non-White patients were more likely to be ineligible for trials based on these lab values. Patients who were ineligible for these trials were less likely to be cured with front-line therapy compared with those who met trial inclusion criteria.
To ensure the broadest possible group of patients can benefit from clinical trial participation—and ultimately benefit from therapies that have been well tested in diverse populations—researchers say further study is needed to determine which lab-based eligibility criteria are most meaningful to inform future trial designs.
Watch future issues of The ASCO Post for more on these studies and others presented during the ASH Annual Meeting.
DISCLOSURE: Dr. Donald and Dr. Cushman reported no conflicts of interest. Dr. Maurer has received research funding from Roche/Genentech, MorphoSys, Genmab, and BMS; and has served on a board of directors or advisory committee for Genmab and Adaptive Biotechnologies.
1. Farmakis I, Cushman M, Valerio L, et al: Social determinants of health and pulmonary embolism treatment and mortality: The Nationwide Inpatient Sample. 2022 ASH Annual Meeting and Exposition. Abstract 140. Presented December 10, 2022.
2. Khurana A, Mwangi R, Nastoupil L, et al: Evaluating the impact of lab-based eligibility criteria by race/ethnicity in frontline clinical trials for diffuse large B-cell lymphoma: A LEO cohort analysis. 2022 ASH Annual Meeting and Exposition. Abstract 850. Presented December 12, 2022.