Sociodemographic Survival Disparities for Lung Cancer in the United States, 2000-2016

Abstract

Abstract Background Understanding the impact of patient and tumor characteristics on lung cancer survival can help build personalized prognostic models and identify health disparities. Methods We identified 557 555 patients aged 25 years and older diagnosed with lung or bronchus carcinoma from the Surveillance, Epidemiology, and End Results database, 2000-2016. We estimated hazard ratios (HR) for demographic (sex, age, race and ethnicity), tumor (stage, histology, year of diagnosis), and geographic characteristics (census tract–level urbanicity, socioeconomic status [SES]), as well as selected interactions, on the rate of lung cancer–specific death using multivariable proportional hazards models. Results Women had a higher survival (lower hazard) of lung cancer–specific death than men (HR = 0.83, 95% confidence interval [CI] = 0.82 to 0.83). Hazards differed by race and ethnicity. Regional (HR = 2.41, 95% CI = 2.37 to 2.44) and distant (HR = 6.61, 95% CI = 6.53 to 6.69) tumors were associated with a lower survival (higher hazard) than localized tumors. Small cell tumors were associated with a lower survival (HR = 1.19, 95% CI = 1.18 to 1.20) than non–small cell tumors. Patients diagnosed after 2009 had lower hazards (HR = 0.86, 95% CI = 085 to 0.86) than those diagnosed 2000-2009. Lung cancer–specific survival did not depend on urbanicity after adjusting for census tract–level SES, but survival decreased with decreasing census tract–level SES. Differences in survival between non-Hispanic Black and White patients were greater for younger patients and localized tumors and increased with census tract–level SES. Differences by sex were greatest for young patients and localized tumors. Conclusions Disparities in survival after lung cancer diagnosis remain, with intersectional patterns suggesting differential access to and quality of care. Efforts are needed to ensure that high-risk groups receive guideline-concordant treatment.