title: The role of patient, tumour and system factors in socioeconomic inequalities in lung cancer treatment: population-based study.
abstract: BACKGROUND
  Reducing socioeconomic inequalities in lung cancer treatment may reduce survival inequalities. However, the reasons for treatment variation are unclear.
  
  
  METHODS
  Northern and Yorkshire cancer registry, Hospital Episode Statistics and lung cancer audit data sets were linked. Logistic regression was used to explore the role of stage, histology, performance status and comorbidity in socioeconomic inequalities in lung cancer treatment, for 28,733 lung cancer patients diagnosed in 2006-2010, and in a subgroup with stage recorded (n=7769, 27%).
  
  
  RESULTS
  Likelihood of receiving surgery was significantly lower in the most deprived group (odds ratio (OR)=0.75, 95% confidence interval (CI) 0.65-0.86); however, the OR was attenuated when including histological subtype (OR=0.82, 95% CI 0.71-0.96). Patients in the most deprived group were significantly less likely to receive chemotherapy in the fully adjusted full cohort model including performance status (OR=0.64, 95% CI 0.58-0.72) but not in the staged subgroup model when performance status was included (OR=0.88, 95% CI 0.72-1.08). Socioeconomic inequalities in radiotherapy were not found.
  
  
  CONCLUSIONS
  Socioeconomic inequalities in performance status statistically explained socioeconomic inequalities in receipt of chemotherapy in the selective staged subgroup, but not in the full cohort. Socioeconomic variation in histological subtype may account for some of the socioeconomic inequalities in surgery.
authors.affiliation: 1] Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK [2] Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
authors.forename: L F
authors.initials: LF
authors.lastname: Forrest
authors.affiliation: 1] Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK [2] Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
authors.forename: M
authors.initials: M
authors.lastname: White
authors.affiliation: 1] Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK [2] Wolfson Research Institute, Durham University, Queens Campus, Stockton on Tees TS17 6BH, UK.
authors.forename: G
authors.initials: G
authors.lastname: Rubin
authors.affiliation: 1] Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK [2] Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
authors.forename: J
authors.initials: J
authors.lastname: Adams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004739:England; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D012959:Socioeconomic Factors