Background: Multiple myeloma (MM) disproportionately affects racial and ethnic minority populations, with growing evidence indicating disparities in access to care and clinical outcomes. However, national-level evaluations within inpatient settings remain limited. This study aims to examine and address these disparities using a large, nationally representative dataset.

Methods: We conducted a retrospective study using the National Inpatient Sample (2016–2022) to examine adult hospitalizations with a primary diagnosis of MM. Patients were stratified by race/ethnicity into the following groups: White (reference), Black, Hispanic, Asian/Pacific Islander, Native American/Other, and Unknown. Survey-weighted analyses were used to assess associations between race/ethnicity and key outcomes, including in-hospital mortality, treatment utilization, complications, and healthcare resource use. Multivariable logistic regression models were employed to adjust for patient demographics, comorbidities, and hospital characteristics.

Results:

Among an estimated 774,675 MM hospitalizations, 63.5% were White, 22.5% Black, 8.4% Hispanic, and 3.1% Asian/Pacific Islander. Black patients were significantly younger (67.3 vs. 70.9 years) and more likely to reside in low-income ZIP codes (47% vs. 19%) compared to White patients. Adjusted odds ratio (aOR) of receiving chemotherapy were higher for Black patients (aOR 1.23, p = 0.002), but lower for stem cell transplant (aOR 0.84, p = 0.13). Hispanic and Asian patients had higher odds of in-hospital mortality (Hispanic aOR 1.39, p = 0.001; Asian aOR 1.71, p = 0.003). In-hospital mortality was higher among Native American (7.5%), Asian (6.7%), and other race patients (5.7%) compared to White patients (4.9%)(p < 0.001). Multivariate analysis showed elevated mortality for Hispanic (aOR 1.12, p = 0.03), Asian (aOR 1.39, p = 0.001), Native American (aOR 1.71, p = 0.003), and other (aOR 1.28, p = 0.002) groups vs. Whites. White patients had higher rates of chemotherapy (11.6%), stem cell transplant (11.5%), and clinical trial enrollment (1.0%). Immunotherapy use was lowest among Hispanic (0.03%) and highest among other race patients (0.36%). Adjusted models showed lower odds of chemotherapy for Native American (aOR 0.90, p = 0.522) and other race (aOR 0.85, p = 0.130) groups.

Conclusions:

Marked racial disparities persist in inpatient outcomes, treatment access, and complications among MM hospitalizations. While Black patients were more likely to receive chemotherapy, they remained underrepresented in high-resource therapies. Targeted policies are needed to address inequities in MM care delivery.

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2025
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