title: Socioeconomic position and surgery for early-stage non-small-cell lung cancer: A population-based study in Denmark.
abstract: OBJECTIVE
  To examine possible associations between socioeconomic position and surgical treatment of patients with early-stage non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  In a register-based clinical cohort study, patients with early-stage (stages I-IIIa) NSCLC were identified in the Danish Lung Cancer Register 2001-2008 (date of diagnosis, histology, stage, and treatment), the Central Population Register (vital status), the Integrated Database for Labour Market Research (socioeconomic position), and the Danish Hospital Discharge Register (comorbidity). Logistic regression analyses were performed overall and separately for stages I, II and IIIa.
  
  
  RESULTS
  Of the 5538 eligible patients with stages I-IIIa NSCLC diagnosed 2001-2008, 53% underwent surgery. Higher stage, older age, being female and diagnosis early in the study period were associated with higher odds for not receiving surgery. Low disposable income was associated with greater odds for no surgery in stage I and stage II patients as was living alone for stage I patients. Comorbidity, a short diagnostic interval and small diagnostic volume were all associated with higher odds for not undergoing surgery; but these factors did not appear to explain the association with income or living alone for early-stage NSCLC patients.
  
  
  CONCLUSIONS
  Early-stage NSCLC patients with low income or who live alone are less likely to undergo surgery than those with a high income or who live with a partner, even after control for possible explanatory factors. Thus, even in a health care system with free, equal access to health services, disadvantaged groups are less likely to receive surgery for lung cancer.
authors.affiliation: Danish Cancer Society Research Center, Danish Cancer Society, 49 Strandboulevarden,Copenhagen, Denmark.
authors.forename: Laila
authors.initials: L
authors.lastname: Kærgaard Starr
authors.forename: Merete
authors.initials: M
authors.lastname: Osler
authors.forename: Marianne
authors.initials: M
authors.lastname: Steding-Jessen
authors.forename: Birgitte
authors.initials: B
authors.lastname: Lidegaard Frederiksen
authors.forename: Erik
authors.initials: E
authors.lastname: Jakobsen
authors.forename: Kell
authors.initials: K
authors.lastname: Østerlind
authors.forename: Joachim
authors.initials: J
authors.lastname: Schüz
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.forename: Susanne
authors.initials: S
authors.lastname: Oksbjerg Dalton
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000601:surgery*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010351:Patient Discharge; D044382:Population Groups; D012042:Registries; D012737:Sex Factors; D012959:Socioeconomic Factors