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The role of receipt and timeliness of treatment in socioeconomic inequalities in lung cancer survival: population-based, data-linkage study

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

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Abstract

Background Lung cancer survival is socioeconomically patterned, and socioeconomic inequalities in receipt of treatment have been demonstrated. In England, there are target waiting times for the referral (14days) and treatment intervals (31days from diagnosis, 62days from GP referral). Socioeconomic inequalities in the time intervals from GP referral have been found. Cancer registry, Hospital Episode Statistics and lung cancer audit data were linked in order to investigate the contribution of these inequalities to socioeconomic inequalities in lung cancer survival.Methods Logistic regression was used to examine the likelihood of being alive 2years after diagnosis, by socioeconomic position, for 22967 lung cancer patients diagnosed in 2006-2009, and in a subset with stage recorded (n=5233).Results Socioeconomic inequalities in survival were found in a multivariable analysis adjusted for age, sex, histology, year, timely GP referral, performance status and comorbidity, with those in the most deprived socioeconomic group significantly less likely to be alive after 2years (OR=0.77, 95% CI 0.66 to 0.88, p<0.001). When receipt of treatment was included in the analysis, the association no longer remained significant (OR=0.87, 95% CI 0.75 to 1.00, p=0.06). Addition of timeliness of treatment did not alter the conclusion. Patients treated within guideline targets had lower likelihood of two-year survival.Conclusions Socioeconomic inequalities in survival from lung cancer were statistically explained by socioeconomic inequalities in receipt of treatment, but not by timeliness of referral and treatment. Further research is required to determine the currently unexplained socioeconomic variance in treatment rates.

Publication metadata

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

Publication type: Article

Publication status: Published

Journal: Thorax

Year: 2015

Volume: 70

Issue: 2

Pages: 138-145

Print publication date: 01/02/2015

Online publication date: 12/06/2014

Acceptance date: 21/05/2014

ISSN (print): 0040-6376

ISSN (electronic): 1468-3296

Publisher: BMJ Publishing Group

URL: http://dx.doi.org/10.1136/thoraxjnl-2014-205517

DOI: 10.1136/thoraxjnl-2014-205517

PubMed id: 24923873

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