Racial and socioeconomic differences in time to treatment initiation and outcomes in aggressive non-Hodgkin lymphoma.

Racial and socioeconomic differences in cancer treatment timing are recognized in solid tumors, but comparable data in aggressive non-Hodgkin lymphoma (NHL) remain limited. Using the National Cancer Database (2004-2022), we conducted a retrospective cohort study of 271 472 patients with diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, mantle cell lymphoma (MCL), and peripheral T-cell lymphoma (PTCL) who received multiagent chemotherapy. Time to treatment initiation (TTI) was defined as days from diagnosis to initiation of multiagent chemotherapy. Multivariable logistic regression identified factors associated with TTI ≥31 days, and Cox proportional hazards models assessed associations between TTI and overall survival. Median TTI was 23 days (interquartile range, 12-38). Black patients had higher odds of TTI ≥31 days than White patients across subtypes (adjusted odds ratio range, 1.20-1.34), and Hispanic patients had higher odds in selected subtypes. TTI lengthened over time, with patients diagnosed in 2016-2022 experiencing 18% to 31% higher odds of TTI ≥31 days than those diagnosed in 2004 to 2009. A shorter TTI was associated with worse survival across all subtypes (adjusted hazard ratio range, 0.65-0.85 for 31-60 days vs ≤30 days), likely reflecting confounding by indication. In primary models, Black race was independently associated with higher mortality; however, inverse probability of treatment weighting analyses attenuated Black-White survival differences in DLBCL, Burkitt lymphoma, and MCL, whereas excess mortality persisted in PTCL. These findings highlight racial differences in treatment timing across aggressive NHL subtypes and subtype-specific heterogeneity in survival outcomes, supporting system-level interventions to improve equitable lymphoma care.