Exploring the Intersectionality of Marital Status and Sex on Survival Outcomes in Non-Hodgkin's Lymphoma

INTRODUCTION: Non-Hodgkin's Lymphoma (NHL) survival is influenced by various factors, including marital status and sex. This study explores how these intersecting factors affect cancer-specific (CSS) and overall survival (OS) in NHL patients. OBJECTIVE: To examine the intersection of sex and marital status on survival outcomes among individuals with NHL. METHODOLOGY: We conducted a retrospective cohort study using SEER registry data for individuals aged 18-85 diagnosed with NHL. Cox regression models assessed the influence of marital status and sex on CSS and overall survival OS, adjusting for age, race, household income, disease stage, primary site, and treatment (chemotherapy, radiotherapy, surgery). Kaplan-Meier curves and log-rank tests compared survival distributions. RESULT: The study analyzed 319,013 individuals with NHL from 2000 to 2020. Participants were predominantly white (73.0%) and female (54.7%), with 54.6% married and a median age of 66 years (IQR 55-76). Females exhibited a 33% higher hazard of death for cancer-specific survival (HR = 1.34, 95% CI: 1.30-1.38) and a 40% higher hazard for overall survival (HR = 1.40, 95% CI: 1.37-1.44). The interaction of marital status and sex significantly impacts both CSS and OS among individuals with NHL. Widowed individuals, regardless of sex, showed the highest risk of death; males had a cancer-specific hazard ratio (HR) of 2.50 (95% CI: 2.35-2.65) and overall HR of 2.31 (95% CI: 2.21-2.41), while females had a cancer-specific HR of 3.09 (95% CI: 2.87-3.31) and overall HR of 2.97 (95% CI: 2.82-3.12). Divorced and separated individuals also exhibited elevated risk. Notably, married males had the lowest hazard ratios, with cancer-specific HR of 1.07 (95% CI: 1.03-1.12) and overall HR of 0.87 (95% CI: 0.84-0.89). CONCLUSION: This study highlights that marital status and sex significantly influence survival outcomes in NHL patients. Widowed individuals have the highest mortality risk, while being married is associated with better survival, especially for males. These findings emphasize the role of social support and gender-specific factors in NHL prognosis.