The invisible divide: The impact of race and location on multiple myeloma outcomes in Arkansas

Abstract Cancer survival rates in the United States have seen remarkable improvements attributed to early detection, enhanced screening practices, and innovative treatments. However, these advancements have not translated equally to all communities, particularly among minorities and rural populations. This disparity is amplified by the prevalence of certain cancers, such as multiple myeloma (MM), which disproportionately affects older adults and exhibits significant ethnic disparities. Black people are 2-5 times more likely to develop the disease compared to those of European descent. MM is a malignancy of plasma cells and in 2023, it is expected that in the US there will be 35,730 new MM diagnoses and 12,590 associated deaths. This study focuses on MM patients in Arkansas, where racial segregation and rural population density contribute to healthcare access challenges and poorer outcomes. We retroactively analyzed a dataset composed of 4,639 patients treated at the University of Arkansas for Medical Sciences that have all received a transplant as part of their treatment. In this study, we performed a descriptive analysis of patients’ outcomes with MM treated in Arkansas. We look at the non-metro versus metro areas while also looking at racial differences in survival outcomes between Black and White patients. To pinpoint specific areas of Arkansas with high disparities, we divided the state into 6 regions. Taken in aggregate, there was no significant difference in progression-free survival (PFS) or overall survival (OS). Just looking at the best and worst performing regions, we compared the Central Arkansas region to the Lower Delta. A significant difference was observed in PFS and OS, with p-values of 0.00034 and 0.025, respectively. Patients from the Central region had a significantly higher survival probability. We observed a significant difference in PFS and OS by race (p-value 0.012 and 0.062). We see that Black patients from the Lower Delta had the worst PFS, and PFS was similar between Black and White patients from the Central region. Interestingly, White patients from the Lower Delta had the worst overall survival probability. Black patients from the Central region had the best OS. This research highlights the disparities between non-metro and metro MM patients, as well as the disparities between Black and White populations in Arkansas compared to the rest of the country. Rural region had the largest disparity in PFS and OS compared to the metro Central region of Arkansas. Black patients from the Lower Delta region have worse PFS than African Black patients from the Central region, and White patients from the Lower Delta region have worse OS than White patients from the Central region. These findings emphasize the importance of targeted education efforts aimed at physicians and patients in rural communities, which could potentially lead to significant improvements in MM outcomes and bridge the existing disparities. Citation Format: Michael A. Bauer, Mario Shootman, Chenghui Li, Frits Van Rhee, Samer Al Hadidi, Carolina D. Schinke, John D. Shaughnessy, Joseph L. Su, Fenghuang Zhan, Cody Ashby. The invisible divide: The impact of race and location on multiple myeloma outcomes in Arkansas [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B104.