Socioeconomic disparities in survival among follicular lymphoma patients

Within a universal healthcare system, the prognostic influence of socioeconomic status (SES) on survival in follicular lymphoma (FL) remains unclear. Thus, we conducted a nationwide, population-based analysis linking cancer registry data with regional SES indicators. Data from patients diagnosed with FL between 2013 and 2023 with mortality follow-up until the end of 2024 were obtained from the German Center for Cancer Registry and linked to the German Index of Socioeconomic Deprivation (GISD) at the district level, which comprises indicators of education, employment, and income. The primary endpoint was relative survival (RS) and secondary endpoint overall survival (OS), comparing patients from low-, middle-, and high-SES districts (categories based on official GISD quintiles). In total, 36 622 FL patients from 400 districts were included. At five years about 80% in female patients and about 77% in male patients were alive. After adjustment for baseline characteristics, females and males in high-SES districts had a 16% and 19% lower excess mortality risk than those in low-SES districts. Further adjustment for degree of urbanity, access to certified centers and a proxy for health-related lifestyle and comorbidities attenuated these differentials considerably. In this first study in a universal healthcare context, SES was an important determinant of survival among FL patients. Proxies for degree of urbanity, access to healthcare and comorbidity at the district-level appeared to account for a substantial part of these differences.