Research Article For reprint orders, please contact: reprints@futuremedicine.com Effects of center type and socioeconomic factors on early mortality and overall survival of diffuse large B-cell lymphoma Prajwal Dhakal* ,1,2 , Baojiang Chen 3 , Smith Giri 4 , Julie M Vose 1,2 , James O Armitage 1,2 & Vijaya Raj Bhatt 1,2 1 Department of Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE 68198, USA 2 Department of Internal Medicine, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA 3 Department of Biostatistics, University of Texas Health Science Center at Houston, College of Public Health in Austin, Austin, TX 78701, USA 4 Department of Internal Medicine, Division of Hematology & Oncology, Yale University, New Haven, CT 06510, USA *Author for correspondence: Tel.: +1 402 559 5600; Fax: +1 402 559 6520; prazwal@gmail.com Aim: To examine whether the center type and socioeconomic factors significantly impact 1-month mor- tality and overall survival (OS) of patients with diffuse large B-cell lymphoma (DLBCL). Methods: National Cancer Database (NCDB) was used to identify patients diagnosed with diffuse large B-cell lymphoma from 2006 to 2012 (postrituximab era). Results: Among 185,183 patients, 33% were treated at academic cen- ters. The receipt of therapy at larger volume centers was associated with improved 1-month mortality. Academic centers had better OS than nonacademic centers in univariable analysis. Younger age, private insurance, lower Charlson comorbidity score and lower lymphoma stage were associated with improved 1-month mortality and OS. Conclusion: The receipt of therapy at larger volume centers and socioeconomic factors were associated with improved survival. First draft submitted: 5 August 2018; Accepted for publication: 18 March 2019; Published online: 30 May 2019 Keywords: academic center • cancer care • center volume • diffuse large B-cell lymphoma • disparity • mortality • socioeconomic factors • survival Prior studies have demonstrated significant racial and socioeconomic disparities in survival of patients with diffuse large B-cell lymphoma (DLBCL) [1–5]. Studies in different lymphoid malignancies report that gender, age, race, socioeconomic status and type of insurance affect all aspects of management from diagnosis, treatment and survival [6–9]. One study conducted in the UK suggested that, while performance status was more discriminatory for survival than just age, socioeconomic factors were not predictive of overall survival (OS) [10]. Whether socioeconomic and other factors affect early mortality in DLBCL remains unknown. Non-Hodgkin’s lymphoma (NHL) patients treated at higher volume centers often have better survival than those treated at lower volume centers [11]. However, it is unclear whether academic status of centers, rather than just volume of patients, affects mortality in patients with DLBCL. Here we utilize a large national database from the USA in postrituximab era with the primary objective of examining the effect of center type (academic status and center volume) on 1-month mortality and OS. Our secondary objective was to evaluate the impact of socioeconomic status on 1-month mortality and OS. Methods Data source & patient selection This retrospective study utilized the National Cancer Database (NCDB) Participant User File (PUF) to identify patients with DLBCL. NCDB, established in 1989, is a joint program of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society and captures approximately 70% of new cancer diagnosis from more than 1500 accredited cancer programs in the USA. The database has previously been used to analyze and track patients with malignancies, their treatments and outcomes [12,13]. Future Oncol. (2019) 15(18), 2113–2124 ISSN 1479-6694 2113 10.2217/fon-2018-0596 C  2019 Future Medicine Ltd