title: Inequalities in lung cancer care of elderly patients with schizophrenia: an observational cohort study.
abstract: OBJECTIVE
  Cancer mortality is higher in individuals with schizophrenia, a finding that may be due, in part, to inequalities in care. We evaluated gaps in lung cancer diagnosis, treatment, and survival among elderly individuals with schizophrenia.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database linked to Medicare records was used to identify patients 66 years or older with primary non-small cell lung cancer. Lung cancer stage, diagnostic evaluation, and rates of stage-appropriate treatment were compared among patients with and without schizophrenia using unadjusted and multiple regression analyses. Survival was compared among groups using Kaplan-Meier methods.
  
  
  RESULTS
  Of the 96,702 patients with non-small cell lung cancer in the Surveillance, Epidemiology, and End Results database, 1303 (1.3%) had schizophrenia. In comparison with the general population, patients with schizophrenia were less likely to present with late-stage disease after controlling for age, sex, marital status, race/ethnicity, income, histology, and comorbidities (odds ratio = 0.82, 95% confidence interval = 0.73-0.93) and were less likely to undergo appropriate evaluation (p < .050 for all comparisons). Adjusting for similar factors, patients with schizophrenia were also less likely to receive stage-appropriate treatment (odds ratio = 0.50, 95% confidence interval = 0.43-0.58). Survival was decreased among patients with schizophrenia (mean survival = 22.3 versus 26.3 months, p = .002); however, no differences were observed after controlling for treatment received (p = .40).
  
  
  CONCLUSIONS
  Elderly patients with schizophrenia present with earlier stages of lung cancer but are less likely to undergo diagnostic evaluation or to receive stage-appropriate treatment, resulting in poorer outcomes. Efforts to increase treatment rates for elderly patients with schizophrenia may lead to improved survival in this group.
authors.affiliation: From the Doris Duke Clinical Research Fellowship (C.B.), UMDNJ-Robert Wood Johnson Medical School, Camden, New Jersey; and Divisions of General Internal Medicine (K.S, G.M., M.K, J.W.) Pulmonary and Critical Care (J.W.), Mount Sinai School of Medicine, New York, New York.
authors.forename: Cara
authors.initials: C
authors.lastname: Bergamo
authors.forename: Keith
authors.initials: K
authors.lastname: Sigel
authors.forename: Grace
authors.initials: G
authors.lastname: Mhango
authors.forename: Minal
authors.initials: M
authors.lastname: Kale
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D000367:Age Factors; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D018426:SEER Program; D012559:Schizophrenia / Q000401:mortality*; D012720:Severity of Illness Index; D015996:Survival Rate; D014481:United States / Q000453:epidemiology