Work

Health care funding and education independently predict survival in DLBCL: a large real-world study from Brazil

Year: 2026

Type: article

Abstract: ABSTRACT Background In real-world settings, diffuse Large B-cell Lymphoma (DLBCL) outcomes may be influenced by healthcare system characteristics and socioeconomic factors. Brazil’s dual system includes a government-funded public system and a supplementary private sector. However, their impact on DLBCL survival remains poorly characterized. Methods We conducted a retrospective cohort study using the São Paulo State Hospital Cancer Registry (HCR-SP) to evaluate the association between healthcare funding source, educational attainment, and time to treatment initiation (TTI) with overall survival (OS) in untreated DLBCL patients (ages 18–99) between 2015–2020. Five-year OS was estimated using Kaplan–Meier methods, and factors associated with mortality were assessed using multivariate Cox proportional hazards models. Results 2,396 patients were included (85.8% public, 14.2% private), with a five-year OS rate of 53.6%. Treatment within the public system was associated with worse survival, varying according to age and sex. Factors independently associated with a higher risk of death included lower educational attainment and shorter time to treatment initiation, the latter likely reflecting aggressive disease biology. In patients aged 18–64 years, public treatment was associated with significantly higher mortality in both women and men. In patients aged ≥65 years, this association persisted only in women. Conclusions In this real-world cohort, structural and socioeconomic factors independently predicted survival in DLBCL, suggesting that healthcare system disparities may affect lymphoma outcomes and underscoring the need for policies to reduce structural barriers to equitable cancer care.

Source: Blood Global Hematology

DOI: 10.1016/j.bglo.2026.100159