title: Improvements in survival after follicular lymphoma by race/ethnicity and socioeconomic status: a population-based study.
abstract: OBJECTIVE
  A recent report suggested improvements in survival after follicular lymphoma (FL), but not for all racial/ethnic groups. To better understand the reasons for these FL survival differences, we examined the joint influences of diagnostic period, race/ethnicity, and neighborhood socioeconomic status (SES) on survival in a large population-based case series.
  
  
  METHODS
  All patients (n = 15,937) diagnosed with FL between 1988 and 2005 in California were observed for vital status through November 2007. Overall and FL-specific survival were analyzed with Kaplan-Meier and Cox proportional hazards regression. Neighborhood SES was assigned from United States Census data using residence at diagnosis.
  
  
  RESULTS
  Overall and FL-specific survival improved 22% and 37%, respectively, from 1988 to 1997 to 1998 to 2005, and were observed in all racial/ethnic groups. Asian/Pacific Islanders had better survival than non-Hispanic white, Hispanic, and black patients who had similar outcomes. Lower neighborhood SES was associated with worse survival in patients across all stages of disease (P for trend < .01). Patients with the lowest SES quintile had a 49% increased risk of death from all causes (hazard ratio [HR] = 1.49, 95% CI, 1.30 to 1.72) and 31% increased risk of death from FL (HR = 1.31; 95% CI, 1.06 to 1.60) than patients with the highest SES.
  
  
  CONCLUSIONS
  Evolving therapies have likely led to improvements in survival after FL. Although improvements have occurred within all racial/ethnic groups, lower neighborhood SES was significantly associated with substantially poorer survival.
authors.affiliation: Northern California Cancer Center, Fremont, CA 94538, USA. tkeegan@nccc.org
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.forename: Laura A
authors.initials: LA
authors.lastname: McClure
authors.forename: James M
authors.initials: JM
authors.lastname: Foran
authors.forename: Christina A
authors.initials: CA
authors.lastname: Clarke
mesh_terms: D000368:Aged; D044383:Black People; D002140:California / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008224:Lymphoma, Follicular / Q000401:mortality*; D008297:Male; D044468:Native Hawaiian or Pacific Islander; D044469:Racial Groups; D012959:Socioeconomic Factors; D001741:Black or African American