Disparities in Stage at Diagnosis of Hodgkin's Lymphoma Among Hispanics in the US: A Population-Based Study
Authors: Jeri Yabar Antoine , Vittini-Hernandez Liliana , Asrani Roshan , Carrasco-Yalán Antonio A. 
Published: December 2024

Background: Racial disparities have been documented in the survival outcomes of both Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL), with Hispanics and Non-Hispanic Black cohort experiencing worse overall survival compared to the Non-Hispanic White population. Previous studies have also highlighted disparities in the stage at diagnosis for various cancers, including lung cancer, within the Hispanic community. However, limited information is available for HL. This study aims to evaluate the disparities in the initial stage at diagnosis of HL among different racial and ethnic groups in the United States, providing insight into potential systemic barriers and guiding efforts to improve early detection and equitable healthcare access.

Methods: We conducted a retrospective population-based cohort study using the Surveillance, Epidemiology and End Results (SEER) Database spanning from 2018 to 2021. A retrospective analysis was done on 6,474 patients diagnosed with histologically confirmed HL aged 15 years and older. Demographic variables such as age, sex, race and stage at diagnosis, geographic location, presence of B symptoms, chemotherapy, radiation, surgery, median household income, and marital status were included. Ordinal logistic regression analysis was employed to determine the odds of being diagnosed at a later stage, adjusting for age, sex, income, geographic location (rural vs. urban), and presence of B symptoms.

Results: Out of 6474 patients with HL, the majority were Non-Hispanic White (62.02%), followed by Hispanic (18.87%), Non-Hispanic Black (11.67%), Non-Hispanic Asian/Pacific Islander (6.85%), and Non-Hispanic American Indian (0.51%). Most patients were in the 15-49 years age category. Regarding the stage at diagnosis, the majority were diagnosed at stage II (40.21%), followed by stage IV (26.37%). Notably, 31.34% of Hispanics were diagnosed at stage IV (p&lt;0.001), compared to 24.51% of Non-Hispanic Whites. Older age was associated with an increased risk of later-stage diagnosis (40-59 years: AOR 1.13, 95% CI: 1.01-1.26, p=0.02; 60-79 years: AOR 1.51, 95% CI: 1.33-1.72, p&lt;0.001; 80+ years: AOR 1.45, 95% CI: 1.12-1.87, p=0.004). Females were less likely to be diagnosed at later stages compared to males (AOR 0.82, 95% CI: 0.75-0.90, p&lt;0.001). The presence of B symptoms was associated with a later stage at diagnosis (AOR 2.83, 95% CI: 2.58-3.11, p&lt;0.001). Hispanics were more likely to be diagnosed at later stages compared to Non-Hispanic Whites (AOR 1.32, 95% CI: 1.17-1.49, p&lt;0.001).

Conclusions: Based on SEER database cohort study spanning from 2018-2021, significant racial disparities were ascertained in the initial diagnosis of HL. Hispanics were 32% more likely to be diagnosed at later stages of HL compared to Non-Hispanic Whites. Potential explanations for the identified disparities include differences in disease biology, socio-economic factors, system-based barriers resulting in delayed treatment and lack of access to healthcare. Other important factors to consider include recent migration to the U.S., unfamiliarity with the U.S. healthcare system, fear of stigma and deportation among undocumented immigrants, and language barriers. Our study highlights the critical need for targeted interventions to improve early detection and ensure equitable access to healthcare across racial groups. Future research should focus on identifying the underlying causes of these disparities and developing strategies to improve early diagnosis within the Hispanic community.