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Socio-Economic Inequalities in Lung Cancer Treatment: The Role of Histological Subtype and Performance Status

Lookup NU author(s): Dr Lynne Forrest, Dr Jean Adams


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Background Socio-economic inequalities in receipt of lung cancer treatment have been demonstrated in our recently published systematic review and meta-analysis, in both universal (UHCS) and non-universal healthcare systems. These findings could not be explained by type of healthcare system or stage at diagnosis. However, not all of the included studies reported details of stage and histology, both of which influence treatment type, and very few UHCS studies took co-morbidity into account. Performance status (PS), a measure of general patient wellbeing, might also be an important determinant of lung cancer treatment. The review recommended that the reasons for socio-economic inequalities in treatment be more thoroughly investigated. Cancer registry (NYCRIS), Hospital Episode Statistics (HES) and lung cancer audit (LUCADA) data-sets from the North-east of England were linked in order to examine the influence of stage, histology, PS and co-morbidity on socio-economic inequalities in lung cancer treatment. Methods NYCRIS data for 65,210 patients with a primary diagnosis of lung cancer (ICD10 C33 and C34), diagnosed between 1999 and 2010 were analysed. Of these, 18,896 had a linked HES co-morbidity record. Subgroup analysis of the 7773 patients diagnosed between 2006 and 2010, who had stage and PS recorded in LUCADA, was also carried out. Multivariable logistic regression was used to examine the likelihood of receipt of surgery, chemotherapy and radiotherapy by socioeconomic position (SEP), taking into account age, sex, histology, year of diagnosis and co-morbidity, and, for the subgroup, stage and PS. Results Socioeconomic inequalities in receipt of surgery and chemotherapy, but not radiotherapy, were found in the full cohort after control for age, sex, histology, year of diagnosis and co-morbidity. The odds of receiving surgery were significantly lower in the lowest compared to the highest SEP group (OR 0.68 [95% CI 0.63, 0.75], p < 0.001) and this remained in the subgroup when stage and PS were additionally controlled for (0.62 [0.46, 0.83], p < 0.001). Inequalities in receipt of surgery were substantially attenuated by histological subtype. Patients in the lowest SEP group were significantly less likely to receive chemotherapy in the full cohort (0.56 [0.52, 0.60], p < 0.001), but not in the subset when stage and PS were included in the model (0.85 [0.70, 1.03], p=0.09). Conclusion Socio-economic differences in PS may account for the observed socio-economic differences in receipt of chemotherapy. Socio-economic inequalities in receipt of surgery may be partially explained by socio-economic differences in tumour type.

Publication metadata

Author(s): Forrest LF, Adams J, White M

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Society for Social Medicine 57th Annual Scientific Meeting

Year of Conference: 2013

Pages: A25-A25

ISSN: 1470-2738

Publisher: BMJ Publishing Group


DOI: 10.1136/jech-2013-203126.50

Series Title: Journal of Epidemiology & Community Health