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Third-World Hodgkin's disease at Los Angeles County-University of Southern California Medical Center
1Department of Internal Medicine, Los Angeles County-University of Southern California Medical Center.
Insights
Hodgkin's disease (HD) in the US presents differently across diverse populations. Lower socioeconomic status and minority groups often experience more advanced, symptomatic disease compared to predominantly white, high-SES populations.
Area of Science:
- Oncology
- Epidemiology
- Public Health
Background:
- Hodgkin's disease (HD) data in the US typically comes from high socioeconomic status (SES), predominantly white populations in referral centers.
- These studies often report nodular sclerosis (NS) subtype and early-stage asymptomatic disease.
Purpose of the Study:
- To characterize Hodgkin's disease (HD) presentation in a heterogeneous, lower SES patient population at a non-referral medical center.
- To compare clinical and pathological features of HD across different racial/ethnic groups.
Main Methods:
- Retrospective review of 178 Hodgkin's disease (HD) patient records from Los Angeles County-University of Southern California Medical Center (LAC/USC) over 17 years.
- Analysis of patient demographics, socioeconomic status (SES), race/ethnicity, presenting symptoms (B symptoms), disease stage, histologic subtype, and extranodal involvement.
Main Results:
- The LAC/USC patient population was racially diverse (38% white, 22% black, 36% Hispanic) with a lower SES.
- A significant proportion presented with advanced disease (stage III/IV, 63%) and systemic B symptoms (62%).
- Hispanics showed a higher incidence of lymphocyte-depleted subtype and less NS. Blacks and Hispanics more frequently presented with advanced stage disease. Extranodal involvement patterns differed by race/ethnicity.
Conclusions:
- The clinical and pathological characteristics of Hodgkin's disease (HD) in this lower SES, mixed racial population resemble those reported in Third-World countries.
- Findings suggest significant variation in HD presentation within the United States based on patient ethnicity and socioeconomic status (SES).
Abstract:
The reported experience with Hodgkin's disease (HD) in the United States has come primarily from large referral centers that attract a predominantly white population of high socioeconomic status (SES). The majority of these patients had the nodular sclerosis (NS) histologic subtype and asymptomatic stage I/II disease. We have reviewed the records of 178 patients with HD seen within the past 17 years at Los Angeles County-University of Southern California Medical Center (LAC/USC), which is a nonreferral, government-operated facility. Our patient population was found to be heterogeneous, with 38% white, 22% black, and 36% Hispanic. Systemic "B" symptoms were noted in 62% of patients at diagnosis, and 63% had advanced disease (stage III or IV). NS pathologic subtype was present in only 52% of the group. Comparison between the races revealed: (1) Hispanics had a higher incidence of lymphocyte depleted subtype and less NS than whites (P less than .06); (2) whites had equal distribution between stages I/II and III/IV; (3) blacks and Hispanics presented more frequently with stage III/IV (P = .10); and (4) extranodal involvement occurred most often in bone in whites, and was equally distributed between liver, lung, and bone in blacks and Hispanics. We conclude that the lower SES, mixed racial population seen at our institution more closely resembles the reports of HD in Third-World countries and is characterized by advanced symptomatic disease. Further, the clinical pathologic characteristics of HD in the United States may vary significantly, depending upon the precise ethnic and socioeconomic status of the patients being served.