Excess mortality by patient’s multimorbidity, socioeconomic, and healthcare factors, among Diffuse Large B–cell and Follicular lymphomas patients in England: A population-based multilevel study

Abstract Background Socioeconomic inequalities of survival in patients with non–Hodgkin lymphoma (NHL) persists, which may be explained by patients’ comorbidities. We aimed to assess the association between co/multimorbidity and survival in patients diagnosed with Diffuse Large B-cell (DLBCL) or Follicular lymphoma (FL) in England accounting for other socio-demographic characteristics. Methods Population-based cancer registry data was linked to Hospital Episode Statistics. We used a flexible multilevel excess hazard model to estimate 5–year net survival and excess mortality by patient’s multimorbidity and comorbidity status adjusted for sociodemographic, economic, healthcare factors, and accounting for the patient’s area of residence. Results Overall, 15,516 and 29,898 patients were diagnosed with FL and DLBCL in England between 2005–2013, respectively. Respectively, those with comorbidities and multimorbidities had 1.3 (95% Confidence Interval -CI-: 1.20–1.40) and 1.5 (95% CI 1.27–1.87) times higher excess mortality compared to those without comorbidities. Patients in most deprived areas showed 26% (95% CI 1.20–1.32) excess mortality risk compared to those in least deprived areas. Conclusion Co/multimorbidities are consistently associated with poorer survival among patients diagnosed with DLBCL or FL. Comorbidities and multimorbidity need to be considered when planning public health interventions targeting haematological malignancies in England.