Racial Disparities in in-Hospital Outcomes of Venous Thromboembolic Events in Patients with Diffuse Large B-Cell Lymphoma
Authors: Saparov Dosbai , Becerra Henry , Wasifuddin Mustafa , Uche Ifeanyi Nnamdi , Gold-Olufadi Shakirat , Abdyraimov Azamat , Hakobyan Narek , Abowali Hesham Ali , Pokhrel Akriti , Yadav Ruchi , Aslam Rukhsana , Shrestha Neharika , Markov Aleksandr , Wang Jen Chin 
Published: December 2024

Introduction:

The incidence of venous thromboembolic events (VTE) is higher among cancer patients, especially while on chemotherapy [1]. Diffuse large B-cell lymphoma (DLBL) is the most common type of lymphoma [2]. Patients with DLBCL are at an increased risk of VTE, with a 2-year cumulative incidence of 16% [3]. Another study focusing on patients over 60 years old demonstrated that elderly patients with DLBCL are at a heightened risk of VTE, which leads to increased healthcare utilization. It was also found that Asian individuals were associated with a lower risk of VTE. Additionally, a history of VTE before DLBCL was associated with an increased risk of post-DLBCL VTE [4]. While the incidence of VTE in DLBCL patients is known, race distribution and their impact on in-hospital outcomes (IHO) remain underexplored. Our study aims to describe the race impact on IHO ofVTE among patients with DLBCL.

Materials and Methods:

DLBCL ≥ 18-year-old hospitalized patients from the National Inpatient Sample (NIS) database between 2016-2020 were obtained. Statistical analyses were performed using STATA V18.0. Continuous variables were analyzed to determine their distribution, medians or means were estimated accordingly. Categorical variables were compared using the Chi-squared test, and a multivariate regression was performed to identify factors that impact the length of stay (LOS), total hospital costs (THC), IHO, and VTE. General and stratified analyses by race were performed. A p≤0.05 was considered statistically significant.

Results:

In a study, 80,850 cases were identified, with a mean age of 65 years. The mean age of Black patients was 58 years (SE:0.46,95%CI:5.21-59.01), followed by Hispanics (60, SE:0.40,95%CI:59.10-60.65), Asian (63, SE:2.36,95%CI:58.99-68.13), Whites (67, SE:0.16, 95%CI:66.44-67.08). The mean LOS for Black patients was 13.3 days (SE: 0.37,95%CI:12.65-14.11), followed by Hispanics (12.7, SE:0.35,95%CI:12.05-13.40), Other races (12.67, SE:0.73,95%CI:11.24-14.10), Asian (12.48, SE:0.50,95%CI:11.51-13.45), White (11.52, SE:0.14,95%CI:11.24-11.79). The highest mean total charges were observed for Asian patients ($217,709.3, SE:$14,292.51,95%CI:$189,694.6-$245,724), followed by Hispanic patients ($217,060.9, SE:$10,124.16,95%CI:$197,216.5-$236,905.2). Black patients had a higher probability of stroke (3.66%) compared to white patients with an OR:1.65 (95%CI:1.21-2.25,p=0.001). Hispanics exhibited a higher probability of DVT (7.53%) with an OR:1.30 (95%CI:1.07-1.57,p=0.008), while Asians had a lower probability of DVT (3.68%), OR:0.61 (95%CI:0.41-0.91,p=0.015). Mortality was higher (9.22%) among patients categorized as Other races, OR:1.62 (95%CI:1.26-2.06,p&lt;0.001). Differences were not found in the risk of pulmonary embolism (PE).

Conclusion:

Significant differences in Age, LOS, IHO, and VTE were observed among racial groups. Our findings contribute to the understanding of the impact of race on VTE and mortality among patients with DLBCL. Black and Hispanic patients are particularly vulnerable to higher rates of stroke and DVT, respectively, while Asian patients exhibit lower probabilities of DVT. These findings highlight the need for targeted interventions and tailored thromboprophylaxis strategies to address and mitigate these differences in DLBCL outcomes. A limitation of our study is that the rate of VTE in patients treated outside hospital settings was not included due to the scope of the analyzed database.

References: Mulder FI, Horváth-Puhó E, van Es N, et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood. 2021;137(14):1959-1969. doi:10.1182/blood.2020007338Abufara AO, Ma'koseh M, Mansour A, et al. 1776P - High incidence of venous thromboembolic events (VTE) in patients with diffuse large b-cell lymphoma. Annals of Oncology. 2019;30:v725. doi:10.1093/annonc/mdz265.022Civettini I, Cavalca F, Zappaterra A, et al. P1175: THROMBOTIC RISK IN DLBCL: A REAL-LIFE COMPARISON OF THE THROLY AND MODEL IX SCORES. Hemasphere. 2023;7(Suppl ):e27260d1. Published 2023 Aug 8. doi:10.1097/01.HS9.0000971596.27260.d1Gangaraju R, Davis ES, Bhatia S, Kenzik KM. Venous-thromboembolism and associated health care utilization in elderly patients with diffuse large B cell lymphoma. Cancer. 2022;128(12):2348-2357. doi:10.1002/cncr.34210