Prognostic models in PTCL have identified biological factors as predictors of survival. However, the impact of social determinants of health (SDH) on PTCL outcomes remains unexplored.
We conducted a retrospective cohort study to assess the influence of actionable SDH on PTCL mortality across racial groups. The study included White, Hispanic, Asian/Pacific Islander (PI), and Black adults diagnosed with nodal PTCLs in California (2000-2020). Descriptive metrics were analyzed using Chi2 and Wilcoxon rank-sum tests, while Kaplan-Meier statistics estimated mortality. Regression models incorporated patient-level (age, sex, race, stage, CCI, histology, treatment, academic center treatment, payer) and neighborhood-level factors (SES quintile, education, rural/urban). Risk factors with P < .10 in univariate regression were included in multivariable analysis.
Among 6,158 patients (51.8% White, 25.8% Hispanic, 14.7% Asian/PI, 7.6% Black), median survival was longest in Hispanics (33 months) and shortest in Asian/PI (14 months; P = .011). Factors independently linked to inferior lymphoma-specific survival (LSS) included Asian/PI compared with Whites (HR, 1.23; P = .0002), AITL/ALCL compared with PTCL, NOS (AITL HR, 1.14; P = .011; ALCL HR, 1.15; P = .004), academic compared to nonacademic facility-type (HR 0.71; P < .01), Medicare compared with uninsured (HR 1.48, P < .01), and the lowest 3 compared to the highest education quartiles (Q2 HR 1.13; P = .021; Q3 HR 1.14; P = .018; Q4 HR 1.22; P < .001). Academic center treatment significantly improved LSS (101 vs. 17 months; P < .01).
Treatment facility, payer, and education are independent, actionable SDH for PTCL mortality. Treatment center-type had the strongest prognostic association with LSS, conferring a risk reduction of PTCL mortality by nearly 30%.
