title: The role of receipt and timeliness of treatment in socioeconomic inequalities in lung cancer survival: population-based, data-linkage study.
abstract: BACKGROUND
  Lung cancer survival is socioeconomically patterned, and socioeconomic inequalities in receipt of treatment have been demonstrated. In England, there are target waiting times for the referral (14 days) and treatment intervals (31 days from diagnosis, 62 days from GP referral). Socioeconomic inequalities in the time intervals from GP referral have been found. Cancer registry, Hospital Episode Statistics and lung cancer audit data were linked in order to investigate the contribution of these inequalities to socioeconomic inequalities in lung cancer survival.
  
  
  METHODS
  Logistic regression was used to examine the likelihood of being alive 2 years after diagnosis, by socioeconomic position, for 22,967 lung cancer patients diagnosed in 2006-2009, and in a subset with stage recorded (n=5233).
  
  
  RESULTS
  Socioeconomic inequalities in survival were found in a multivariable analysis adjusted for age, sex, histology, year, timely GP referral, performance status and comorbidity, with those in the most deprived socioeconomic group significantly less likely to be alive after 2 years (OR=0.77, 95% CI 0.66 to 0.88, p<0.001). When receipt of treatment was included in the analysis, the association no longer remained significant (OR=0.87, 95% CI 0.75 to 1.00, p=0.06). Addition of timeliness of treatment did not alter the conclusion. Patients treated within guideline targets had lower likelihood of two-year survival.
  
  
  CONCLUSIONS
  Socioeconomic inequalities in survival from lung cancer were statistically explained by socioeconomic inequalities in receipt of treatment, but not by timeliness of referral and treatment. Further research is required to determine the currently unexplained socioeconomic variance in treatment rates.
authors.affiliation: Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Lynne F
authors.initials: LF
authors.lastname: Forrest
authors.affiliation: Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Adams
authors.affiliation: Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK Wolfson Research Institute, Durham University, Queen's Campus, Stockton on Tees, UK.
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
authors.affiliation: Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: White
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000401:mortality* / Q000628:therapy; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055752:Small Cell Lung Carcinoma / Q000191:economics / Q000401:mortality* / Q000628:therapy; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors; D061665:Time-to-Treatment
keywords: Clinical Epidemiology; Lung Cancer; Non-Small Cell Lung Cancer; Small Cell Lung Cancer