Introduction: The association between socioeconomic status (SES) and its impact on cancer diagnosis, treatment, and outcomes have been studied over several decades. In multiple myeloma (MM), data present some discrepancies. The aim of this study was to analyze the association between SES and clinical characteristics at MM presentation.
Methods: Clinical and demographic data were retrospectively collected from medical records of all patients diagnosed with MM between January 2015 and February 2023, treated in two public hospitals (an university and a military one) and one private institution, in Rio de Janeiro, Brazil. To assess social class, it was administered the Brazilian Economic Classification Criteria (BECC) version 2021to patients, or to a family member in case of death. The information about the patient's educational level was collected during this interview or from medical records, and per capita income was estimated based on the neighborhood for patients living in Rio de Janeiro and on the municipality for those from other cities. To analyze the associations between SES and MM clinical presentation, patients were categorized as from higher or lower social class (AB x CDE), higher or lower educational level (≤ 9 x > 9 years of study), and with higher or lower income (according to median values found).
Results: A total of 296 patients diagnosed between 2015 and 2023 from three institutions in Rio de Janeiro, Brazil, were included.For SES assessment, a social class questionnaire was administered to 231 patients or relatives; information about educational level was collected from 239 individuals and per capita income was estimated for 280 cases. Patients from higher social classes had a higher frequency of comorbidities, compared to those from lower classes. However, patients from lower social classes had a longer time from first symptom to the date of bone marrow evaluation, a higher proportion of Durie Salmon stage III and hemoglobin values < 8.5 g/dL, and also higher calcium values, when compared to patients from higher social classes. Among individuals who studied up to 9 years, there was a higher proportion of females, patients with performance status ≥ 2 and delayed diagnosis than those with more than 9 years of study. Individuals with higher estimated per capita income were older than those with lower income. Additionally, a higher proportion of patients with lower income presented with PS ≥ 2 and with symptoms at diagnosis. Among these individuals, the median hemoglobin value was lower, when compared to those with higher income.
Conclusions: Lower SES was associated with delayed diagnosis, symptoms at presentation, advanced stage, poorer performance status, lower hemoglobin and higher calcium values. These findings underscore the importance of shaping health policies to promote greater equity in cancer diagnosis and treatment access.
