Table 4.

Summary of descriptive characteristics of included studies evaluating marital status (n = 10) and education level (n = 19)

Author (year)Data source
years
US regionPatients
N
Outcome/analysisCohortsHR (95%-CI)Social determinant
associated with worse survival
Marital status 
Yung et al,19 (2011) NYSCR
2001–2008 
NY HL
4752 
OS/multi Married
Unmarried 
Ref.
1.49 (1.11-1.99)  
Unmarried 
 CCR
2000–2007 
CA HL
4752 
OS/multi Married
Unmarried 
Ref.
1.26 (0.97-1.64) 
Tao et al,25 (2014) CCR
2001-2009 
CA NHL
16 133 
CSS/multi Married
Never married
Previously married 
Ref.
1.13 (1.07-1.20),
1.13 (1.09-1.18)  
Unmarried 
Huang et al,31 (2021) SEER
2007-2016 
National MM
17 981 
CSS/multi Married
Single 
Ref.
1.15 (1.06-1.24)  
Single 
    OS/multi Married
Single
Other 
Ref.
1.29 (1.22-1.38),
1.35 (1.26-1.44)  
Single, divorced, separated, domestic partner, or widowed 
Makhani (2021) SEER
2007-2016 
National MM
41 789 
OS/multi Married
Not Married 
Ref.
1.18 (1.13-1.22)  
Unmarried 
Evans et al,40 (2021) Institutional 2005-2015 NS MM
2543 
OS/multi Married
Unmarried 
Ref.
1.32 (1.03-1.69)  
Unmarried 
Costa et al,37 
2016 
SEER
2007-2012 
National MM
10 161 
1-year mortality Married
Divorced
Single
Widowed 
Ref.
1.31 (1.09-1.58),
1.74 (1.48-2.03),
1.38 (1.01-1.88)  
Divorced, single or widowed 
Ho et al,24 (2017) CCR
1999-2012 
CA MM
6359 
60-day mortality Married
Single 
Ref.
1.25 (1.07-1.46)  
Single 
Yung et al,19 (2011) NYSCR
2001–2008 
NY AML
3506 
OS/multi Married
Unmarried 
Ref.
1.25 (1.07-1.45)  
Unmarried 
 CCR
2000–2007 
CA AML
3506 
OS/multi Married
Unmarried 
Ref.
1.31 (1.17-1.48)  
Unmarried 
Borate et al,38 (2015) SEER
2007-2011 
National AML
5541 
OS/multi Married
Single
Divorced
Widowed 
Ref.
1.26 (1.15-1.38),
1.16 (1.04-1.30) 
1.14 (0.93-1.41) 
Single or divorced 
    OS/multi Married
Divorced
Single
Widowed 
Ref.
1.24 (1.11-1.39),
1.39 (1.27-1.53),
1.43 (1.20-1.71)  
Divorced, single, or widowed 
Perry et al,16 (2017) SEER
2007-2012 
National CML 15-64 y.o.
3626 
OS/multi Married
Single
Divorced/separated/widowed 
Reference
1.65 (1.29-2.13) 
1.30 (0.94-1.79) 
Single 
   CML 65 y.o.
2142 
OS/multi Married
Single
Divorced, separated, or widowed 
Ref.
1.15 (0.89-1.48)
1.35 (1.16-1.59)  
Divorced, widowed, or separated 
Education: percentage of population without high school degree 
Parikh et al,39 (2015) NCDB
1998-2011 
National HL
45 777 
OS/uni ≥ 29%
20%-28.9%
14%-19.9%
<14% 
Ref.
0.83 (0.78-0.89),
0.78 (0.74-0.83),
0.62 (0.58-0.66)  
Higher than 29% 
    OS/multi ≥ 29%
20%-28.9%
14%-19.9%
<14% 
Ref.
0.98 (0.86-1.13)
1.14 (0.98-1.32)
0.97 (0.82-1.13) 
Goldstein et al,21 (2019) NCDB
2004–2014 
National NHL ≥ 65y.o.
161 
OS/uni < 7%
7% to 12.9%
13% to 20.9%
> 21% 
Ref.
1.18 (0.7-2)
1.09 (0.6-1.9)
1.75 (1.3-1) 
Han (2014) NCDB
2004-2010 
National NHL
3 858 
OS/multi < 14%
14%-9.9%
20%-28.9%
≥ 29% 
Ref.
1.17 (0.99-1.39)
1.27 (1.07-1.50),
1.51 (1.25-1.82)  
Higher than 20% 
Shah (2019) NCDB
2004-2013 
National NHL
18 120 
OS/multi < 7%
≥ 21%
13%-20%
7%-12.99% 
Ref.
1.14 (1.03-1.27),
1.16 (1.07-1.26),
1.12 (1.05-1.20)  
Higher than 7% 
Goldstein et al,21 (2019) NCDB
2004-2014 
National NHL < 65 y.o.
22 133 
OS/multi < 7%
7%-12.9%
13%-20.9%
> 21% 
Ref.
1.19 (1.05-1.34),
1.40 (1.24-1.59),
1.42 (1.22-1.64)  
Higher than 7% 
   NHL ≥ 65 y.o.
21 515 
OS/multi < 7%
7%-12.9%
13%-20.9%
> 21% 
Ref.
1.03 (0.96-1.11)
1.09 (1.01-1.18),
1.19 (1.09-1.31)  
Higher than 13% 
Dhakal et al,22 (2019) NCDB
2006-2012 
National NHL
132 402 
1-month mortality/Uni NS Data not showed Lower education level 
Gunaratne et al,35 (2021) NCBD
2004-2014 
National WM
3064 
OS/multi High 
Middle-2
Middle-1
Low 
Ref.
1.16 (0.96-1.4)
1.30 (1.04-1.63)
1.28 (0.97-1.69) 
Chohan et al,18 (2022) NCDB
2004-2017 
National WM < 65 y.o.
1249 
OS/uni ≥ 17.6%
10.9%–17.5%
6.3%–10.8%
<6.3% 
Ref.
0.90 (0.56-1.43)
0.81 (0.52-1.28)
0.58 (0.36-0.93)  
Higher than 17.6% 
    OS/multi ≥ 17.6%
10.9%–17.5%
6.3%–10.8%
<6.3% 
Ref.
1.02 (0.59-1.78)
1.02 (0.55-1.88)
0.86 (0.43-1.75) 
   WM ≥ 65 y.o.
2629 
OS/multi ≥ 17.6%
10.9%–17.5%
6.3%–10.8%
<6.3% 
Ref.
0.97 (0.75-1.26)
0.98 (0.75-1.27)
0.84 (0.72-0.97)  
Higher than 17.6% 
Goldstein et al,21 (2019) NCDB
2004–2014 
National BL 65 y.o.
5235 
OS/multi < 7%
7% to 12.9%
13% to 20.9%
> 21% 
Ref.
1.1 (0.9-1.3)
1.35 (1.1-1.6)
1.39 (1.1-1.7)  
Higher than 21% 
   BL ≥ 65 y.o.
1838 
OS/multi < 7%
7% to 12.9%
13% to 20.9%
> 21% 
Ref.
0.8 (0.6-1),
0.9 (0.7-1.2),
0.72 (0.5-1)  
Higher than 7% 
Evans et al,40 (2021) Institutional 2005-2015 NS MM
2543 
OS/uni ≤ 7%
>7% 
Ref.
1.02 (0.88-1.18) 
 NCDB
2004-2015 
National MM
2543 
OS/multi ≤ 7%
>7% 
Ref.
1.08 (1.06-1.11)  
Higher than 7% 
Jayakrishnan (2021) NCDB
2004-2016 
National MM
50 543 
OS/multi ≥ 21%
13.0%-20.9%
7.0%-12.9%
< 7.0% 
Ref.
0.99 (0.95-1.02)
0.98 (0.94-1.02)
0.94 (0.89-0.99)  
Higher than 21% 
Costa et al,37 (2016) SEER
2007-2012 
National MM
10 161 
12 month- mortality/multi < 21.3%
> 36.8%
29.7%-36.8%
21.3%-29.7% 
Ref.
0.92 (0.72-1.17)
1.03 (0.80-1.32)
1.34 (1.05-1.72)  
From 21.3% to 29.7% 
Huang et al,31 (2021) SEER
2007-2016 
National MM
17 981 
CSS/uni 6.83%–21.52%
21.62%–30.99%
31.08%–34.03%
34.07%–41.84%
42.01%–65.45% 
Ref.
0.87 (0.80-0.96),
0.87 (0.79-0.95),
0.87 (0.80-0.96),
0.80 (0.73-0.88)  
From 68.3% to 21.52% 
    OS/uni < 21.3%
> 36.8%
29.7%-36.8%
21.3%-29.7% 
Ref.
1.13 (1.02-1.27),
1.19 (1.07-1.33),
1.46 (1.31-1.62)  
Higher than 21.3% 
    CSS/multi 6.83%–21.52%
21.62%–30.99%
31.08%–34.03%
34.07%–41.84%
42.01%–65.45% 
Ref.
0.95 (0.85-1.06)
0.93 (0.82-1.05)
1.02 (0.89-1.17)
0.96 (0.82-1.13) 
    OS/uni 6.83%–21.52%
21.62%–30.99%
31.08%–34.03%
34.07%–41.84%
42.01%–65.45% 
Ref.
0.88 (0.81-0.94),
0.91 (0.85-0.98),
0.80 (0.75-0.86),
0.68 (0.63-0.74)  
From 6.83% to 21.52% 
    OS/multi 6.83%–21.52%
21.62%–30.99%
31.08%–34.03%
34.07%–41.84%
42.01%–65.45% 
Ref.
0.98 (0.90-1.06)
1.07 (0.97-1.18)
1.02 (0.92-1.14)
0.90 (0.79-1.03) 
Freeman et al,32 (2016) NC CCR
2003-2009 
NC AML
900 
OS/multi NS 1.00 (0.99-1.02) 
Master et al,28 (2016) NCDB
1998 -2012 
National AML.
67 443 
OS/multi < 14%
14%-19.9%
20%-28.9%
≥ 29% 
Ref.
1.03 (1.00-1.06),
1.05 (1.02-1.08) 
1.01 (0.97-1.05) 
From 14% to 28.9% 
Borate et al,38 (2015) SEER
2007-2011 
National AML
5541 
OS/uni Quintile 5 
Quintile1
Quintile 2
Quintile 3
Quintile 4 
Ref.
1.27 (1.13-1.42) 
1.17 (1.05-1.31)
1.17 (1.04-1.31)
1.15 (1.02-1.30) 
Lower education level 
Dhakal et al,17 (2022) NCDB
2004-2015 
National APL <65 y.o.
5380 
1-month mortality <6.3
6.3-10.8
10.9-17.5
≥17.6 
Ref.
1.18 (0.86-1.61)
1.02 (0.72-1.46)
1.40 (0.96-2.06) 
   APL ≥65 y.o.
1520 
1-month mortality <6.3
6.3-10.8
10.9-17.5
≥17.6 
Ref.
1.38- (0.95-2.02)
1.14 (0.73-1.76)
1.18 (0.71-1.97) 
   APL <65 y.o.
5380 
OS/multi <6.3
6.3-10.8
10.9-17.5
≥17.6 
Ref.
0.99 (0.83-1.19)
1.08 (0.89-1.32)
1.14 (0.91-1.43) 
   APL ≥65 y.o.
1520 
OS/multi <6.3
6.3-10.8
10.9-17.5
≥17.6 
Ref.
1.12 (0.91-1.37)
1.12 (0.89-1.41)
1.11 (0.85-1.45) 
Perry et al,16 (2017) SEER
2007-2012 
National CML 15-64 y.o.
3626 
OS/multi Below median
Above median 
Ref.
1.05 (0.73-1.52) 
   CML ≥ 65 y.o.
2142 
OS/multi Below median
Above median 
Ref.
1.20 (0.94-1.53) 
Education: percentage of population without <ninth grade degree 
Perry et al,16 (2017) SEER
2007-2012 
National CML 15-64 y.o.
3626 
OS/HR Above median % ninth grade education NS 
   CML ≥ 65 y.o.
2142 
OS/HR Above median % ninth grade education NS 
Author (year)Data source
years
US regionPatients
N
Outcome/analysisCohortsHR (95%-CI)Social determinant
associated with worse survival
Marital status 
Yung et al,19 (2011) NYSCR
2001–2008 
NY HL
4752 
OS/multi Married
Unmarried 
Ref.
1.49 (1.11-1.99)  
Unmarried 
 CCR
2000–2007 
CA HL
4752 
OS/multi Married
Unmarried 
Ref.
1.26 (0.97-1.64) 
Tao et al,25 (2014) CCR
2001-2009 
CA NHL
16 133 
CSS/multi Married
Never married
Previously married 
Ref.
1.13 (1.07-1.20),
1.13 (1.09-1.18)  
Unmarried 
Huang et al,31 (2021) SEER
2007-2016 
National MM
17 981 
CSS/multi Married
Single 
Ref.
1.15 (1.06-1.24)  
Single 
    OS/multi Married
Single
Other 
Ref.
1.29 (1.22-1.38),
1.35 (1.26-1.44)  
Single, divorced, separated, domestic partner, or widowed 
Makhani (2021) SEER
2007-2016 
National MM
41 789 
OS/multi Married
Not Married 
Ref.
1.18 (1.13-1.22)  
Unmarried 
Evans et al,40 (2021) Institutional 2005-2015 NS MM
2543 
OS/multi Married
Unmarried 
Ref.
1.32 (1.03-1.69)  
Unmarried 
Costa et al,37 
2016 
SEER
2007-2012 
National MM
10 161 
1-year mortality Married
Divorced
Single
Widowed 
Ref.
1.31 (1.09-1.58),
1.74 (1.48-2.03),
1.38 (1.01-1.88)  
Divorced, single or widowed 
Ho et al,24 (2017) CCR
1999-2012 
CA MM
6359 
60-day mortality Married
Single 
Ref.
1.25 (1.07-1.46)  
Single 
Yung et al,19 (2011) NYSCR
2001–2008 
NY AML
3506 
OS/multi Married
Unmarried 
Ref.
1.25 (1.07-1.45)  
Unmarried 
 CCR
2000–2007 
CA AML
3506 
OS/multi Married
Unmarried 
Ref.
1.31 (1.17-1.48)  
Unmarried 
Borate et al,38 (2015) SEER
2007-2011 
National AML
5541 
OS/multi Married
Single
Divorced
Widowed 
Ref.
1.26 (1.15-1.38),
1.16 (1.04-1.30) 
1.14 (0.93-1.41) 
Single or divorced 
    OS/multi Married
Divorced
Single
Widowed 
Ref.
1.24 (1.11-1.39),
1.39 (1.27-1.53),
1.43 (1.20-1.71)  
Divorced, single, or widowed 
Perry et al,16 (2017) SEER
2007-2012 
National CML 15-64 y.o.
3626 
OS/multi Married
Single
Divorced/separated/widowed 
Reference
1.65 (1.29-2.13) 
1.30 (0.94-1.79) 
Single 
   CML 65 y.o.
2142 
OS/multi Married
Single
Divorced, separated, or widowed 
Ref.
1.15 (0.89-1.48)
1.35 (1.16-1.59)  
Divorced, widowed, or separated 
Education: percentage of population without high school degree 
Parikh et al,39 (2015) NCDB
1998-2011 
National HL
45 777 
OS/uni ≥ 29%
20%-28.9%
14%-19.9%
<14% 
Ref.
0.83 (0.78-0.89),
0.78 (0.74-0.83),
0.62 (0.58-0.66)  
Higher than 29% 
    OS/multi ≥ 29%
20%-28.9%
14%-19.9%
<14% 
Ref.
0.98 (0.86-1.13)
1.14 (0.98-1.32)
0.97 (0.82-1.13) 
Goldstein et al,21 (2019) NCDB
2004–2014 
National NHL ≥ 65y.o.
161 
OS/uni < 7%
7% to 12.9%
13% to 20.9%
> 21% 
Ref.
1.18 (0.7-2)
1.09 (0.6-1.9)
1.75 (1.3-1) 
Han (2014) NCDB
2004-2010 
National NHL
3 858 
OS/multi < 14%
14%-9.9%
20%-28.9%
≥ 29% 
Ref.
1.17 (0.99-1.39)
1.27 (1.07-1.50),
1.51 (1.25-1.82)  
Higher than 20% 
Shah (2019) NCDB
2004-2013 
National NHL
18 120 
OS/multi < 7%
≥ 21%
13%-20%
7%-12.99% 
Ref.
1.14 (1.03-1.27),
1.16 (1.07-1.26),
1.12 (1.05-1.20)  
Higher than 7% 
Goldstein et al,21 (2019) NCDB
2004-2014 
National NHL < 65 y.o.
22 133 
OS/multi < 7%
7%-12.9%
13%-20.9%
> 21% 
Ref.
1.19 (1.05-1.34),
1.40 (1.24-1.59),
1.42 (1.22-1.64)  
Higher than 7% 
   NHL ≥ 65 y.o.
21 515 
OS/multi < 7%
7%-12.9%
13%-20.9%
> 21% 
Ref.
1.03 (0.96-1.11)
1.09 (1.01-1.18),
1.19 (1.09-1.31)  
Higher than 13% 
Dhakal et al,22 (2019) NCDB
2006-2012 
National NHL
132 402 
1-month mortality/Uni NS Data not showed Lower education level 
Gunaratne et al,35 (2021) NCBD
2004-2014 
National WM
3064 
OS/multi High 
Middle-2
Middle-1
Low 
Ref.
1.16 (0.96-1.4)
1.30 (1.04-1.63)
1.28 (0.97-1.69) 
Chohan et al,18 (2022) NCDB
2004-2017 
National WM < 65 y.o.
1249 
OS/uni ≥ 17.6%
10.9%–17.5%
6.3%–10.8%
<6.3% 
Ref.
0.90 (0.56-1.43)
0.81 (0.52-1.28)
0.58 (0.36-0.93)  
Higher than 17.6% 
    OS/multi ≥ 17.6%
10.9%–17.5%
6.3%–10.8%
<6.3% 
Ref.
1.02 (0.59-1.78)
1.02 (0.55-1.88)
0.86 (0.43-1.75) 
   WM ≥ 65 y.o.
2629 
OS/multi ≥ 17.6%
10.9%–17.5%
6.3%–10.8%
<6.3% 
Ref.
0.97 (0.75-1.26)
0.98 (0.75-1.27)
0.84 (0.72-0.97)  
Higher than 17.6% 
Goldstein et al,21 (2019) NCDB
2004–2014 
National BL 65 y.o.
5235 
OS/multi < 7%
7% to 12.9%
13% to 20.9%
> 21% 
Ref.
1.1 (0.9-1.3)
1.35 (1.1-1.6)
1.39 (1.1-1.7)  
Higher than 21% 
   BL ≥ 65 y.o.
1838 
OS/multi < 7%
7% to 12.9%
13% to 20.9%
> 21% 
Ref.
0.8 (0.6-1),
0.9 (0.7-1.2),
0.72 (0.5-1)  
Higher than 7% 
Evans et al,40 (2021) Institutional 2005-2015 NS MM
2543 
OS/uni ≤ 7%
>7% 
Ref.
1.02 (0.88-1.18) 
 NCDB
2004-2015 
National MM
2543 
OS/multi ≤ 7%
>7% 
Ref.
1.08 (1.06-1.11)  
Higher than 7% 
Jayakrishnan (2021) NCDB
2004-2016 
National MM
50 543 
OS/multi ≥ 21%
13.0%-20.9%
7.0%-12.9%
< 7.0% 
Ref.
0.99 (0.95-1.02)
0.98 (0.94-1.02)
0.94 (0.89-0.99)  
Higher than 21% 
Costa et al,37 (2016) SEER
2007-2012 
National MM
10 161 
12 month- mortality/multi < 21.3%
> 36.8%
29.7%-36.8%
21.3%-29.7% 
Ref.
0.92 (0.72-1.17)
1.03 (0.80-1.32)
1.34 (1.05-1.72)  
From 21.3% to 29.7% 
Huang et al,31 (2021) SEER
2007-2016 
National MM
17 981 
CSS/uni 6.83%–21.52%
21.62%–30.99%
31.08%–34.03%
34.07%–41.84%
42.01%–65.45% 
Ref.
0.87 (0.80-0.96),
0.87 (0.79-0.95),
0.87 (0.80-0.96),
0.80 (0.73-0.88)  
From 68.3% to 21.52% 
    OS/uni < 21.3%
> 36.8%
29.7%-36.8%
21.3%-29.7% 
Ref.
1.13 (1.02-1.27),
1.19 (1.07-1.33),
1.46 (1.31-1.62)  
Higher than 21.3% 
    CSS/multi 6.83%–21.52%
21.62%–30.99%
31.08%–34.03%
34.07%–41.84%
42.01%–65.45% 
Ref.
0.95 (0.85-1.06)
0.93 (0.82-1.05)
1.02 (0.89-1.17)
0.96 (0.82-1.13) 
    OS/uni 6.83%–21.52%
21.62%–30.99%
31.08%–34.03%
34.07%–41.84%
42.01%–65.45% 
Ref.
0.88 (0.81-0.94),
0.91 (0.85-0.98),
0.80 (0.75-0.86),
0.68 (0.63-0.74)  
From 6.83% to 21.52% 
    OS/multi 6.83%–21.52%
21.62%–30.99%
31.08%–34.03%
34.07%–41.84%
42.01%–65.45% 
Ref.
0.98 (0.90-1.06)
1.07 (0.97-1.18)
1.02 (0.92-1.14)
0.90 (0.79-1.03) 
Freeman et al,32 (2016) NC CCR
2003-2009 
NC AML
900 
OS/multi NS 1.00 (0.99-1.02) 
Master et al,28 (2016) NCDB
1998 -2012 
National AML.
67 443 
OS/multi < 14%
14%-19.9%
20%-28.9%
≥ 29% 
Ref.
1.03 (1.00-1.06),
1.05 (1.02-1.08) 
1.01 (0.97-1.05) 
From 14% to 28.9% 
Borate et al,38 (2015) SEER
2007-2011 
National AML
5541 
OS/uni Quintile 5 
Quintile1
Quintile 2
Quintile 3
Quintile 4 
Ref.
1.27 (1.13-1.42) 
1.17 (1.05-1.31)
1.17 (1.04-1.31)
1.15 (1.02-1.30) 
Lower education level 
Dhakal et al,17 (2022) NCDB
2004-2015 
National APL <65 y.o.
5380 
1-month mortality <6.3
6.3-10.8
10.9-17.5
≥17.6 
Ref.
1.18 (0.86-1.61)
1.02 (0.72-1.46)
1.40 (0.96-2.06) 
   APL ≥65 y.o.
1520 
1-month mortality <6.3
6.3-10.8
10.9-17.5
≥17.6 
Ref.
1.38- (0.95-2.02)
1.14 (0.73-1.76)
1.18 (0.71-1.97) 
   APL <65 y.o.
5380 
OS/multi <6.3
6.3-10.8
10.9-17.5
≥17.6 
Ref.
0.99 (0.83-1.19)
1.08 (0.89-1.32)
1.14 (0.91-1.43) 
   APL ≥65 y.o.
1520 
OS/multi <6.3
6.3-10.8
10.9-17.5
≥17.6 
Ref.
1.12 (0.91-1.37)
1.12 (0.89-1.41)
1.11 (0.85-1.45) 
Perry et al,16 (2017) SEER
2007-2012 
National CML 15-64 y.o.
3626 
OS/multi Below median
Above median 
Ref.
1.05 (0.73-1.52) 
   CML ≥ 65 y.o.
2142 
OS/multi Below median
Above median 
Ref.
1.20 (0.94-1.53) 
Education: percentage of population without <ninth grade degree 
Perry et al,16 (2017) SEER
2007-2012 
National CML 15-64 y.o.
3626 
OS/HR Above median % ninth grade education NS 
   CML ≥ 65 y.o.
2142 
OS/HR Above median % ninth grade education NS 

AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; BL, Burkitt lymphoma; CA, California; CCR, California Cancer Registry; CI, confidential interval; CML, chronic myeloid leukemia; CSS, cancer-specific survival; HL, Hodgkin lymphoma; HR, hazard ratio; MM, multiple myeloma; multi, multivariate analysis; N, sample size; NC, North Carolina; NCDB, National Cancer Database; NC CCR, North Carolina Central Cancer Registry; NHL, non-Hodgkin lymphoma; NOS, not otherwise specified; NS, not specified; NY, New York; NYSCR, New York state cancer registry; Ref., Reference; SEER, Surveillance, Epidemiology, and End Results Registry; uni, univariate analysis; WM, Waldenstrom macroglobulinemia; y.o., years old.

Reported as statistical significance by the author.

Statistical significance but not discussed by the author.

Not specified values.

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