Despite recent advances, socioeconomic disparities in lymphoma outcomes persist, and there is a shortage of real-world data on outcomes of underserved patients. We conducted a retrospective cohort of patients aged ≥18 years diagnosed with lymphoma between January 2011 and June 2022 at Harris Health, Houston, TX, a safety-net hospital system located in the third most populous county in the US. Demographics and baseline disease characteristics were abstracted from the electronic medical record. US Census Block Group FIPS codes derived from geocoded home address were used to compute the Area Deprivation Index (ADI). Of 1,283 patients, 505 had diffuse large B-cell lymphoma, 58 had Burkitt’s lymphoma, 110 had follicular lymphoma (FL), 127 had chronic lymphocytic leukemia/small lymphocytic lymphoma, 74 had marginal zone lymphoma (MZL), 22 had mantle cell lymphoma (MCL), 11 had Waldenström’s macroglobulinemia/lymphoplasmacytic lymphoma, 239 had Hodgkin lymphoma, 91 had T/NK-cell lymphomas, and 46 had other subtypes. The median age was 53 years (range, 18-95); 42% of patients were assigned female at birth, 56% identified as Hispanic, 25% identified as Black, 58% were originally from outside the US, and 45% preferred a language other than English. Three-quarters were uninsured, and 81% were in the two more disadvantaged ADI national quartiles. Fourteen percent had a history of HIV infection. In total, 86% received lymphoma-directed therapy, with a median diagnosis-to-treatment interval of 20 days (range, 0-432). Sixty-eight percent were alive at the time of analysis. Five-year overall survival (Figure) was highest among patients with MZL (93%, 95% CI 88-99%) and FL (92%, 95% CI 87-98%) and lowest among those with T/NK-cell lymphomas (49%, 95% CI 39-61%), MCL (47%, 95% CI 29-75%), and other subtypes (44%, 95% CI 32-62%). Our retrospective study is one of the largest examining underserved patients with lymphoma to date. Efforts to identify outcome disparities are ongoing.

Figure. Overall Survival by Lymphoma Subtype