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The role of patient, tumour and system factors in socioeconomic inequalities in lung cancer treatment: population-based study

Lookup NU author(s): Dr Lynne Forrest, Professor Martin White, Emeritus Professor Greg RubinORCiD, Dr Jean Adams



Background: Reducing socioeconomic inequalities in lung cancer treatment may reduce survival inequalities. However, the reasons for treatment variation are unclear.Methods: Northern and Yorkshire cancer registry, Hospital Episode Statistics and lung cancer audit data sets were linked. Logistic regression was used to explore the role of stage, histology, performance status and comorbidity in socioeconomic inequalities in lung cancer treatment, for 28 733 lung cancer patients diagnosed in 2006-2010, and in a subgroup with stage recorded (n = 7769, 27%).Results: Likelihood of receiving surgery was significantly lower in the most deprived group (odds ratio (OR) = 0.75, 95% confidence interval (CI) 0.65-0.86); however, the OR was attenuated when including histological subtype (OR = 0.82, 95% CI 0.71-0.96). Patients in the most deprived group were significantly less likely to receive chemotherapy in the fully adjusted full cohort model including performance status (OR = 0.64, 95% CI 0.58-0.72) but not in the staged subgroup model when performance status was included (OR = 0.88, 95% CI 0.72-1.08). Socioeconomic inequalities in radiotherapy were not found.Interpretation: Socioeconomic inequalities in performance status statistically explained socioeconomic inequalities in receipt of chemotherapy in the selective staged subgroup, but not in the full cohort. Socioeconomic variation in histological subtype may account for some of the socioeconomic inequalities in surgery.

Publication metadata

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

Publication type: Article

Publication status: Published

Journal: British Journal of Cancer

Year: 2014

Volume: 111

Issue: 3

Pages: 608-618

Print publication date: 10/06/2014

Online publication date: 10/06/2014

Acceptance date: 12/05/2014

Date deposited: 07/08/2015

ISSN (print): 0007-0920

ISSN (electronic): 1532-1827

Publisher: Nature Publishing Group


DOI: 10.1038/bjc.2014.310


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Funder referenceFunder name
British Heart Foundation
Cancer Research UK
Medical Research Council
National Institute for Health Research, under the auspices of the UKCRC
Economic and Social Research Council