Exploring the Intersectionality of Marital Status and Sex on Survival Outcomes in Non-Hodgkin’s Lymphoma

Abstract Introduction Non-Hodgkin’s Lymphoma (NHL) remains a significant public health concern with notable disparities in survival outcomes. Sex and marital status are two critical social determinants that influence both cancer-specific survival (CSS) and overall survival (OS). Prior studies suggest that women with NHL face poorer survival outcomes compared to men, and marital status modulates survival, with married individuals demonstrating better outcomes. However, the interplay between sex and marital status on NHL survival has not been thoroughly examined. Objective To investigate the combined effects of sex and marital status on CSS and OS in NHL patients. Methodology A retrospective cohort study was conducted using SEER registry data spanning 2000 to 2020. Individuals aged 18–85 diagnosed with NHL were included. Cox regression models assessed the interaction between sex and marital status on CSS and OS, adjusting for covariates such as age, race, household income, cancer stage, and treatment modalities. Predicted probabilities of mortality and the differences in sex effects across marital status categories were estimated using interaction terms and linear combinations. Results A total of 291,608 patients were included, with females accounting for 54.6% of the cohort. Sex disparities were observed across marital status groups. Married women exhibited a significantly higher probability of overall mortality than married men (9.26, 95% CI: 7.61–10.92, p < 0.001). The disparity was most pronounced among single individuals, where women had a 22.93-unit higher probability of overall mortality compared to men (95% CI: 18.49–27.37, p < 0.001). Similarly, widowed women had higher probabilities of mortality than widowed men (13.10, 95% CI: 10.08–16.11, p < 0.001). Cancer-specific mortality followed a similar pattern, with single women experiencing the greatest disparity compared to single men (8.44, 95% CI: 6.21–10.68, p < 0.001). Comparisons of effects between marital status groups revealed that single individuals exhibited a 13.67-unit greater disparity in overall mortality than married individuals (95% CI: 10.26–17.07, p < 0.001). Conclusion This study underscores the significant influence of sex and marital status on survival outcomes in NHL patients. Women face higher cancer-specific and overall mortality risks across all marital status categories. Marital status modifies these disparities, with marriage conferring a survival advantage, particularly for men. These findings highlight the need for targeted interventions to address sex and social disparities in NHL outcomes, emphasizing the importance of social support and tailored survivorship care. Key Points Women with NHL have higher overall and cancer-specific mortality than men, with the greatest disparity seen in single individuals. Marriage reduces survival disparities, benefiting men most, while single and widowed women face the highest mortality risks.