# Income and education affect prognosis and treatment in symptomatic myeloma: A population-based study on 8672 multiple myeloma patients diagnosed 2008–2021 from the Swedish myeloma registry

## TL;DR

This study shows that income and education levels affect treatment and survival outcomes for multiple myeloma patients in Sweden, highlighting socioeconomic disparities in healthcare.

## Contribution

The study reveals socioeconomic disparities in myeloma treatment and survival within a publicly funded healthcare system.

## Key findings

- Higher income and education correlate with prolonged survival in myeloma patients.
- Lower-income patients are less likely to receive newer therapies and more likely to receive older treatments.
- Socioeconomic status influences treatment choices and outcomes despite universal healthcare access.

## Abstract

Despite advancements in multiple myeloma treatment, prognostic variability persists. We investigated the impact of income and education on treatment and survival in a country with publicly funded healthcare. We analysed data from the Swedish Myeloma Registry (2008–2021) linked to national registers. Cox models assessed survival, adjusting for demographics and comorbidities. Treatment patterns were compared using cumulative incidence functions. Among 8,672 patients, higher education and income correlated with prolonged survival. Adjusted hazard ratios (HRs) for low income were 1.4 (95% CI 1.3–1.5) and for low education were 1.3 (95% CI 1.2–1.4). Higher income patients were more likely to receive lenalidomide (HR 1.5, 95% CI 1.3–1.6) and pomalidomide (HR 1.7, 95% CI 1.4-2.0), and less likely to receive melphalan tablets (HR 0.8, 95% CI 0.7–0.9). Low-income patients were less likely to undergo stem cell transplant (HR 0.8, 95% CI 0.7–0.9). Immigrant status or biological sex did not influence outcomes. Even in a tax-funded system, socioeconomic disparities impact myeloma survival and treatment. Lower socioeconomic status correlates with inferior outcome and more conservative treatment. Attitudinal biases may contribute to these disparities. Better treatment for the less privileged patients could significantly improve myeloma survival, advocating for efforts to overcome the influence of socioeconomic status.