title: In lung cancer patients, age, race-ethnicity, gender and smoking predict adverse comorbidity, which in turn predicts treatment and survival.
abstract: OBJECTIVE
  This study evaluates the relationship between sociodemographic/exposure factors and comorbidity, and their impact on lung cancer treatment and survival. STUDY AND DESIGN SETTING: Data for 1,155 patients were abstracted from the Josephine Ford Cancer Center Tumor Registry and medical records. Associations were analyzed by linear, logistic, and Cox regression.
  
  
  RESULTS
  Approximately 88% of patients had > or = 1 of 56 comorbidities assessed. In multivariate analysis, comorbidity count was associated with older age, pack-years smoked, heavy alcohol use, lower socioeconomic status (SES), and female gender. Approximately 63% of patients had > or = 1 of 18 adverse prognostic comorbidities (AC), and significant independent predictors of AC were age, pack-years, African-American race/ethnicity, and gender. In multivariate analysis, comorbidity count and AC predicted nonreceipt of surgery in localized disease (OR(> or = 1 vs. 0 AC)=0.38, 95% 0.18, 0.81) and chemotherapy in advanced disease (OR > or = 1 vs. 0 AC)=0.72, 95% 0.51, 1.00). In adjusted analysis, comorbidity predicted survival in localized (hazard ratio (HR)(> or = 2 vs. 0 AC)=2.99, 95% CI 1.75, 5.10) and advanced lung cancer (HR(> or = 2 vs. 0 AC)=1.56, 95% CI 1.25, 1.94).
  
  
  CONCLUSIONS
  Comorbidity has important deleterious effects on lung cancer outcomes and significant predictors of comorbidity included age, smoking, race/ethnicity, SES, alcohol, and gender.
authors.affiliation: Josephine Ford Cancer Center, 1 Ford Place, 5C, Detroit, MI 48202-3450, USA. mtammem1@hfhs.org
authors.forename: C Martin
authors.initials: CM
authors.lastname: Tammemagi
authors.forename: Christine
authors.initials: C
authors.lastname: Neslund-Dudas
authors.forename: Michael
authors.initials: M
authors.lastname: Simoff
authors.forename: Paul
authors.initials: P
authors.lastname: Kvale
mesh_terms: D000367:Age Factors; D015897:Comorbidity; D005006:Ethnicity; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D012923:Social Class; D015996:Survival Rate; D016896:Treatment Outcome