Toggle Main Menu Toggle Search

Open Access padlockePrints

Socio-economic inequalities in stage at diagnosis, and in time from first symptom to treatment, for lung cancer: systematic review and meta-analysis

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


Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


Background Cancer diagnosis at an early stage increases the chance of curative treatment and of survival. It has been suggested that delays on the pathway from first symptom to diagnosis and treatment may be socio-economically patterned, and contribute to socio-economic differences in receipt of treatment and in cancer survival. This review aimed to assess the published and grey literature evidence for socio-economic inequalities in stage at diagnosis of lung cancer, and in the length of time spent on the lung cancer pathway. The interim patient, primary care, referral, diagnostic, and treatment intervals where inequalities might occur were examined. Methods Systematic methods were used to identify relevant studies, assess eligibility for inclusion and evaluate quality. The online databases of MEDLINE, EMBASE and CINAHL were searched to locate cohort studies of adults with a primary diagnosis of lung cancer; where the outcome was stage at diagnosis, or the length of time spent within an interval on the care pathway; analysed by a measure of socio-economic position. Meta-analysis was conducted when there were sufficient studies available with suitable data. Results Of the 454 records screened, 33 papers were included in the review, with 14 of these from the UK. There was no evidence of socio-economic inequalities in late stage at diagnosis in the most, compared to the least, deprived group (n= 5, odds ratio= 1.04, 95% confidence interval= 0.89 to 1.20). No consistent pattern was observed in pre-diagnostic intervals. No socio-economic inequalities in length of time from diagnosis to treatment were found, in the five studies examining this interval. Conclusions Socio-economic inequalities in stage at diagnosis are thought to be an important explanatory factor for survival inequalities in cancer. However, socio-economic inequalities in stage at diagnosis were not found in a meta-analysis for lung cancer. Other patient, tumour and system factors, that might help explain socio-economic inequalities in receipt of treatment and lung cancer survival, need to be investigated.

Publication metadata

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

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: European Public Health Conference

Year of Conference: 2014

Pages: 30-30

Print publication date: 01/10/2014

Online publication date: 31/10/2014

Acceptance date: 06/06/2014

ISSN: 1101-1262

Publisher: Oxford University Press


DOI: 10.1093/eurpub/cku151.064

Series Title: European Journal of Public Health