Abstract

Barriers to health care access may contribute to the poorer survival of Black patients with Non-Hodgkin Lymphoma (NHL) than their White counterparts in the U.S. general population. The Department of Defense's (DoD) Military Health System (MHS) provides universal or equal health care access to all its beneficiaries. This study compared overall survival of NHL patients by race in the MHS and U.S. general population, respectively, and aimed to provide evidence on the role of universal health care in reducing racial disparity. The MHS Patients were identified from the DoD's Central Cancer Registry (CCR) and the patients from the U.S. general population were identified from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. A retrospective cohort study was conducted comparing survival of major NHL subtypes by race in the CCR and the SEER cohorts, respectively. Non-Hispanic Black patients and Non-Hispanic White patients in the CCR cohort had similar survival in Cox regression models sequentially adjusted for different sets of confounders. The hazard ratios (HRs) and 95% confidence intervals (CIs) comparing Black to White patients for diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and other NHLs were 1.25 (0.89-1.78), 0.74 (0.39-1.42), and 1.25 (0.89-1.77) in the full models, respectively. In contrast, Black patients in the SEER cohort exhibited significantly worse survival than White patients in all models adjusting for the same sets of confounders. The HRs were 1.46 (95% CI= 1.40-1.52), 1.57 (95% CI=1.48-1.67), and 1.61 (95% CI=1.54-1.68) in the full models for DLBCL, CLL/SLL and other NHL, respectively. Conclusions Our study supported universal access to health care as an important factor in reducing survival racial disparity among NHL patients.