Introduction

Diagnostic delay is associated with lower chances of cancer survival. Underlying comorbidities are known to affect the timely diagnosis of cancer. Diffuse large B-cell (DLBCL) and follicular lymphomas (FL) are primarily diagnosed amongst older patients, who are more likely to have comorbidities. Characteristics of clinical commissioning groups (CCG) are also known to impact diagnostic delay. We assess the association between comorbidities and diagnostic delay amongst patients with DLBCL or FL in England during 2005–2013.

Methods

Multivariable generalised linear mixed-effect models were used to assess the main association. Empirical Bayes estimates of the random effects were used to explore between-cluster variation. The latent normal joint modelling multiple imputation approach was used to account for partially observed variables.

Results

We included 30,078 and 15,551 patients diagnosed with DLBCL or FL, respectively. Amongst patients from the same CCG, having multimorbidity was strongly associated with the emergency route to diagnosis (DLBCL: odds ratio 1.56, CI 1.40–1.73; FL: odds ratio 1.80, CI 1.45–2.23). Amongst DLBCL patients, the diagnostic delay was possibly correlated with CCGs that had higher population densities.

Conclusions

Underlying comorbidity is associated with diagnostic delay amongst patients with DLBCL or FL. Results suggest a possible correlation between CCGs with higher population densities and diagnostic delay of aggressive lymphomas.

中文翻译：

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调查英格兰弥漫性大 B 细胞或滤泡性淋巴瘤患者诊断途径的不平等

 介绍

诊断延迟与癌症生存机会降低有关。已知潜在的合并症会影响癌症的及时诊断。弥漫性大 B 细胞 (DLBCL) 和滤泡性淋巴瘤 (FL) 主要在老年患者中诊断，他们更有可能患有合并症。众所周知，临床委托组 (CCG) 的特征也会影响诊断延迟。我们评估了 2005 年至 2013 年英国 DLBCL 或 FL 患者的合并症与诊断延迟之间的关联。

 方法

使用多变量广义线性混合效应模型来评估主要关联。随机效应的经验贝叶斯估计用于探索簇间变异。潜在正态联合建模多重插补方法用于解释部分观察到的变量。

 结果

我们分别纳入了 30,078 名和 15,551 名诊断为 DLBCL 或 FL 的患者。在来自同一 CCG 的患者中，患有多种疾病与紧急诊断途径密切相关（DLBCL：比值比 1.56，CI 1.40–1.73；FL：比值比 1.80，CI 1.45–2.23）。在 DLBCL 患者中，诊断延迟可能与人口密度较高的 CCG 相关。

 结论

潜在的合并症与 DLBCL 或 FL 患者的诊断延迟有关。结果表明，人口密度较高的 CCG 与侵袭性淋巴瘤的诊断延迟之间可能存在相关性。