Social Inequalities, Geographical Accessibility to Care, and Excess Mortality for Patients With Hematological Malignancies in France: Results From French Cancer Registries

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Abstract
The effect of geographical accessibility to care and patients' social environment on survival has been little studied for hematological malignancies. The objective was to investigate the influence of these factors on excess mortality for these patients in France. This study included 13 French cancer registries. Hodgkin's lymphomas, myeloid haemopathies, multiple myeloma, chronic lymphatic leukemia, diffuse large B‐cell lymphoma and follicular lymphoma diagnosed between 2013 and 2015 are included ( N = 19,041). Social environment was measured using the European Deprivation Index. The access of secondary care was measured by travel time to the nearest reference care center, and access to primary care was estimated using Spatial Accessibility multiscALar (SCALe) index and Accessibilité Potentielle Localisée (APL). The effects of these indicators on excess mortality were investigated using additive excess hazard models with multidimensional penalized splines. For myeloid haemopathies, only the social environment had a significant effect on excess mortality. For diffuse large B‐cell lymphoma, the travel time to nearest reference care center had an impact on excess mortality. Finally, for follicular lymphoma, an increase of APL index was associated with a decrease of mortality. Our study showed that the social environment and the geographical accessibility to care were prognostic factors for survival in certain hematological malignancies.
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  • Ligue Contre le Cancer

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