Socioeconomic position and survival after lung cancer: Influence of stage, treatment and comorbidity among Danish patients with lung cancer diagnosed in 2004–2010. (May 2015)

• Record Type: Journal Article
• Authors: Dalton, Susanne O.; Steding-Jessen, Marianne; Jakobsen, Erik; Mellemgaard, Anders; Østerlind, Kell; Schüz, Joachim; Johansen, Christoffer
• Is Part Of: Acta oncologica. Volume 54:Number 5(2015)
• Page Start: 797
• Page End: 804
• Publication Date: 2015-05
• Subjects: Oncology -- Periodicals; Cancer -- Treatment -- Periodicals; 616.992
• DOI: 10.3109/0284186X.2014.1001037
• Languages: English
• ISSNs: 0284-186X

Abstract

<abstract> <title>Abstract</title> <p> <bold>Background.</bold> To address social inequality in survival after lung cancer, it is important to consider how socioeconomic position (SEP) influences prognosis. We investigated whether SEP influenced receipt of first-line treatment and whether socioeconomic differences in survival could be explained by differences in stage, treatment and comorbidity.</p> <p> <bold>Material and methods</bold>. In the Danish Lung Cancer Register, we identified 13 045 patients with lung cancer diagnosed in 2004–2010, with information on stage, histology, performance status and first-line treatment. We obtained age, gender, vital status, comorbid conditions and socioeconomic information (education, income and cohabitation status) from nationwide population-based registers. Associations between SEP and receipt of first-line treatment were analysed in multivariate logistic regression models and those with overall mortality in Cox regression models with stepwise inclusion of possible mediators.</p> <p> <bold>Results.</bold> For both low- and high-stage lung cancer, adjusted ORs for first-line treatment were reduced in patients with short education and low income, although the OR for education did not reach statistical significance in men with high-stage disease. Patients with high-stage disease who lived alone were less likely to receive first-line treatment. The socioeconomic difference in overall survival was partly explained by differences in stage, treatment and comorbidity, although some differences remained after adjustment. Among patients with high-stage disease, the hazard ratio (HR) for death of those with low income was 1.12 (95% CI 1.05–1.19) in comparison with those with high income. Among patients with low-stage disease, those who lived alone had a 14% higher risk for dying (95% CI 1.05–1.25) than those who lived with a partner. The differences in risk for death by SEP were greatest in the first six months after diagnosis.</p> <p> <bold>Conclusion.</bold> Socioeconomic differences in survival after lung cancer are partly explained by social inequality in stage, first-line treatment and comorbidity. Efforts should be made to improve early diagnosis and adherence to first-line treatment recommendations among disadvantaged lung cancer patients.</p> </abstract>