title: Neighborhood-level socioeconomic determinants impact outcomes in nonsmall cell lung cancer patients in the Southeastern United States.
abstract: BACKGROUND
  Studies examining the impact of lower socioeconomic status (SES) on the outcomes of patients with nonsmall cell lung cancer (NSCLC) are inconsistent. The objective of this study was to clearly elucidate the association between SES, education, and clinical outcomes among patients with NSCLC.
  
  
  METHODS
  The study population was derived from a consecutive, retrospective cohort of patients with NSCLC who received treatment within the Duke Health System between 1995 and 2007. SES determinants were based on the individual's census tract and corresponding 2000 Census data. Determinants included the percentage of the population living below poverty, the median household income, and the percentages of residents with at least a high school diploma and at least a bachelor's degree. The SES and educational variables were divided into quartiles. Statistical comparisons were performed using the 25th and 75th percentiles.
  
  
  RESULTS
  Individuals who resided in areas with a low median household income or in which a high percentage of residents were living below the poverty line had a shorter cancer-specific 6-year survival than individuals who resided in converse areas (P = .0167 and P = .0067, respectively). Those living in areas in which a higher percentage of residents achieved a high school diploma had improved disease outcomes compared with those living in areas in which a lower percentage attained a high school diploma (P = .0033). A survival advantage also was observed for inhabitants of areas in which a higher percentage of residents attained a bachelor's degree (P = .0455).
  
  
  CONCLUSIONS
  Low SES was identified as an independent prognostic factor for poor survival in patients with both early and advanced stage NSCLC. Patients who lived in areas with high poverty levels, low median incomes, and low education levels had worse mortality.
authors.affiliation: Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27707, USA.
authors.forename: Loretta
authors.initials: L
authors.lastname: Erhunmwunsee
authors.forename: Mary-Beth M
authors.initials: MB
authors.lastname: Joshi
authors.forename: Debbi H
authors.initials: DH
authors.lastname: Conlon
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality*; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012923:Social Class; D015144:Southeastern United States; D055815:Young Adult