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dc.contributor.authorSmith, Matthew J.
dc.contributor.authorLuque Fernández, Miguel Ángel
dc.date.accessioned2022-11-10T07:30:21Z
dc.date.available2022-11-10T07:30:21Z
dc.date.issued2022-10-17
dc.identifier.citationSmith, M.J.; Rachet, B.; Luque-Fernandez, M.A. Mediating Effects of Diagnostic Route on the Comorbidity Gap in Survival of Patients with Diffuse Large B-Cell or Follicular Lymphoma in England. Cancers 2022, 14, 5082. [https://doi.org/10.3390/cancers14205082]es_ES
dc.identifier.urihttps://hdl.handle.net/10481/77860
dc.description.abstractBackground: Socioeconomic inequalities in survival from non-Hodgkin lymphoma persist. Comorbidities are more prevalent amongst those in more deprived areas and are associated with diagnostic delay (emergency diagnostic route), which is also associated with poorer survival probability. We aimed to describe the effect of comorbidity on the probability of death mediated by diagnostic route (emergency vs. elective route) amongst patients with diffuse large B-cell (DLBCL) or follicular lymphoma (FL). Methods: We linked the English population-based cancer registry and hospital admission records (2005–2013) of patients aged 45–99 years. We decomposed the effect of comorbidity on survival into an indirect effect acting through diagnostic route and a direct effect not mediated by diagnostic route. Furthermore, we estimated the proportion of the comorbidity effect on survival mediated by diagnostic route. Results: For both DLBCL (n = 27,379) and FL (n = 14,043), those with any comorbidity, or living in more deprived areas, were more likely to experience diagnostic delay and poorer survival. The indirect effect of comorbidity on mortality through diagnostic route was highest at 12 months since diagnosis (DLBCL: Odds Ratio 1.10 [95% CI 1.07–1.13], FL: OR 1.09 [95% CI 1.04–1.14]). Within the first 12 months since diagnosis, emergency diagnostic route accounted for 24% (95% CI 17.5–29.5) and 16% (95% CI 6.0–25.6) of the comorbidity effect on mortality, for DLBCL and FL, respectively. Conclusion: Efforts to reduce diagnostic delay (emergency diagnosis) amongst patients with comorbidity would reduce inequalities in DLBCL and FL survival by 24% and 16%, respectively. Further public health programs and interventions are needed to reduce diagnostic delay amongst lymphoma patients with comorbidities.es_ES
dc.description.sponsorshipCancer Research UK C7923/A18525es_ES
dc.language.isoenges_ES
dc.publisherMDPIes_ES
dc.rightsAtribución 4.0 Internacional*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectDiffuse large B-cell lymphomaes_ES
dc.subjectFollicular lymphomaes_ES
dc.subjectMediation analysises_ES
dc.subjectEpidemiology es_ES
dc.subjectComorbidityes_ES
dc.subjectSurvivales_ES
dc.titleMediating Effects of Diagnostic Route on the Comorbidity Gap in Survival of Patients with Diffuse Large B-Cell or Follicular Lymphoma in Englandes_ES
dc.typejournal articlees_ES
dc.rights.accessRightsopen accesses_ES
dc.identifier.doi10.3390/cancers14205082
dc.type.hasVersionVoRes_ES


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