Impact of socioeconomic status on disease phenotype, genomic landscape and outcomes in myelodysplastic syndromes.
Genetic and epigenetic alterations contribute to the biological and clinical characteristics of myelodysplastic syndromes (MDS), but a role for socioeconomic environment remains unclear. Here, socioeconomic status (SES) for 283 MDS patients was estimated using the Scottish Index of Multiple Deprivation tool. Indices were assigned to quintile categorical indicators ranked from SES1 (lowest) to SES5 (highest). Clinicopathological features and outcomes between SES quintiles containing 15%, 20%, 19%, 30% and 16% of patients were compared. Prognostic scores identified lower-risk MDS in 82% of patients, with higher-risk disease in 18%. SES quintiles did not associate with age, gender, cytogenetics, International Prognostic scores or, in sub-analysis (n = 95), driver mutations. The odds ratio of a diagnosis of refractory anaemia was greater than other MDS sub-types in SES5 (OR 1·9, P = 0·024). Most patients (91%) exclusively received supportive care. SES did not associate with leukaemic transformation or cause of death. Cox regression models confirmed male gender (P < 0·05), disease-risk (P < 0·0001) and age (P < 0·01) as independent predictors of leukaemia-free survival, with leukaemic transformation an additional determinant of overall survival (P = 0·07). Thus, if access to healthcare is equitable, SES does not determine disease biology or survival in MDS patients receiving supportive treatment; additional studies are required to determine whether outcomes following disease-modifying therapies are influenced by SES.
Dundee Cancer Centre, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK.
Francesca
F
Mastaglio
Division of Population Health Sciences, University of Dundee, Dundee, UK.|Photobiology Unit, Department of Dermatology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK.
Khaled
K
Bedair
Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK.
Elli
E
Papaemmanuil
Dundee Cancer Centre, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK.
Michael J
MJ
Groves
Department of Haematology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK.
Ann
A
Hyslop
Department of Haematology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK.
Norene
N
Keenan
Division of Population Health Sciences, University of Dundee, Dundee, UK.
Eleanor J
EJ
Hothersall
Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK.
Peter J
PJ
Campbell
St James's Institute of Oncology, Leeds, UK.
David T
DT
Bowen
Dundee Cancer Centre, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK.|Department of Haematology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK.
Sudhir
S
Tauro
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000753:Anemia, Refractory; D002423:Cause of Death; D002471:Cell Transformation, Neoplastic; D005260:Female; D023281:Genomics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000191:economics / Q000401:mortality*; D010641:Phenotype; D011379:Prognosis; D012307:Risk Factors; D012923:Social Class; D016896:Treatment Outcome
International Prognostic Scoring System; Socioeconomic status; genomic; healthcare; myelodysplastic syndromes; outcomes