[Lung cancer: survival rate differences in Danish counties. Survival analysis of 33.838 patients during the period 1984-1998].
BACKGROUND
The quality of care for Nordic cancer patients has been considered to be low in Denmark. Our quality problem was believed to be caused by the structure of our secondary health care. But there may be other explanations for the poor survival in Denmark, and the comparison with the other Nordic countries may be flawed by confounding factors, such as smoking habits and spread of cancer at the time of diagnosis. We therefore, analysed differences in regional survival after diagnosis of carcinoma of the lung in Denmark to look for signs of similar flaws.


METHODS
A sample from the National Cancer Registry of all cases of carcinoma of the lung, diagnosed in 1984-1995. Persons older than 80 were excluded. Age and spread of cancer were included in a Cox analysis.


RESULTS
Survival was dependent on residence. Within the first five months of diagnosis, survival was significantly poorer in Copenhagen City and better in the counties of Aarhus, Aalborg, and Viborg. At five months, the differences had diminished and only the counties of Fyn and Sønderjylland differed from the nationel average in a negative way.


CONCLUSIONS
Better results were achieved than previously expected in some Danish counties. Interpretation of the Nordic results should be more critical and include possible confounders, such as smoking and spread of cancer at diagnosis. The Danish problem with cancer may be because of the delay of patient and doctor in the primary health care, together with an extreme life-style, including too much urban life and tobacco smoking.
Madsen
Flemming F
FF
Intern medicinsk klinik B, H:S Frederiksberg Hospital, DK-2000 Frederiksberg. flem-mad@dadlnet.dk
Nørskov
Bente
B
Frølund
Lars
L
Hanash
Jamal A
JA
D000328:Adult; D000368:Aged; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008019:Life Style; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012424:Rural Population; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D015996:Survival Rate; D014505:Urban Population