title: Socioeconomic disparities in lung cancer treatment and outcomes persist within a single academic medical center.
abstract: BACKGROUND
  Socioeconomic disparities in treatment and outcomes of non-small-cell lung cancer (NSCLC) are well established. To explore whether these differences are secondary to individual or institutional characteristics, we examined treatment selection and outcome in a diverse population treated at a single medical center.
  
  
  METHODS
  We performed a retrospective analysis of consecutive patients diagnosed with NSCLC stages I-III from 2000 to 2005 at the University of Texas Southwestern Medical Center. Treatment selection was dichotomized as 'standard' (surgery for stage I-II; surgery and/or radiation therapy for stage III) or 'other.' Associations between patient characteristics (including socioeconomic status) and treatment selection were examined using logistic regression; associations between characteristics and overall survival were examined using Cox regression models and Kaplan-Meier survival analysis.
  
  
  RESULTS
  A total of 450 patients were included. Twenty-eight percent of patients had private insurance, 43% had Medicare, and 29% had an indigent care plan. The likelihood of receiving 'standard' therapy was significantly associated with insurance type (indigent plan versus private insurance odds ratio [OR] 0.13, 95% confidence interval [CI] 0.04, 0.43 for stage I-II; OR 0.38, 95% CI 0.14, 1.00 for stage III). For patients with stage I-II NSCLC, survival was associated with age, sex, insurance type (indigent plan versus private insurance hazard ratio for death 1.98; 95% CI 1.16, 3.37), stage, and treatment selection. In stage III NSCLC, survival was associated with treatment selection.
  
  
  CONCLUSIONS
  Within a single academic medical center, socioeconomically disadvantaged patients with stage I-III NSCLC are less likely to receive 'standard' therapy. Socioeconomically disadvantaged patients with stage I-II NSCLC have inferior survival independent of therapy.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Yorio
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Yan
authors.forename: Yang
authors.initials: Y
authors.lastname: Xie
authors.forename: David E
authors.initials: DE
authors.lastname: Gerber
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009367:Neoplasm Staging; D011203:Poverty; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate; D013781:Texas; D016896:Treatment Outcome; D017664:Uncompensated Care / Q000191:economics; D014481:United States