Social inequalities in non-small cell lung cancer management and survival: a population-based study in central Sweden.
OBJECTIVE
To examine possible associations between socioeconomic status, management and survival of patients with non-small cell lung cancer (NSCLC).


METHODS
In a population-based cohort study, information was retrieved from the Regional Lung Cancer Register in central Sweden, the Cause of Death Register and a social database. ORs and HRs were compared to assess associations between educational level and management and survival.


RESULTS
3370 eligible patients with an NSCLC diagnosis between 1996 and 2004 were identified. There were no differences in stage at diagnosis between educational groups. A higher diagnostic intensity was observed in patients with high compared with low education. There were also social gradients in time between referral and diagnosis in early stage disease (median time: low, 32 days; high, 17 days). Social differences in treatment remained following adjustment for prognostic factors (surgery in early stage disease, high vs low OR 2.84; CI 1.40 to 5.79). Following adjustment for prognostic factors and treatment, the risk of death in early stage disease was lower in women with a high education (high vs low HR 0.33; CI 0.14 to 0.77).


CONCLUSIONS
The results of this study indicate that socioeconomically disadvantaged groups with NSCLC receive less intensive care. Low education remained an independent predictor of poor survival only in women with early stage disease. The exact underlying mechanisms of these social inequalities are unknown, but differences in access to care, co-morbidity and lifestyle factors may all contribute.
Berglund
Anders
A
Department of Medical Epidemiology and Biostatistics, Box 281, Karolinska Institutet, 171 77 Stockholm, Sweden. anders.berglund@ki.se
Holmberg
Lars
L
Tishelman
Carol
C
Wagenius
Gunnar
G
Eaker
Sonja
S
Lambe
Mats
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004522:Educational Status; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012923:Social Class; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014850:Waiting Lists