title: What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK?
abstract: BACKGROUND
  The UK has poor lung cancer survival rates and high early mortality, compared to other countries. We aimed to identify factors associated with early death, and features of primary care that might contribute to late diagnosis.
  
  
  METHODS
  All cases of lung cancer diagnosed between 2000 and 2013 were extracted from The Health Improvement Network database. Patients who died within 90 days of diagnosis were compared with those who survived longer. Standardised chest X-ray (CXR) and lung cancer rates were calculated for each practice.
  
  
  RESULTS
  Of 20,142 people with lung cancer, those who died early consulted with primary care more frequently prediagnosis. Individual factors associated with early death were male sex (OR 1.17; 95% CI 1.10 to 1.24), current smoking (OR 1.43; 95% CI 1.28 to 1.61), increasing age (OR 1.80; 95% CI 1.62 to 1.99 for age ≥80 years compared to 65-69 years), social deprivation (OR 1.16; 95% CI 1.04 to 1.30 for Townsend quintile 5 vs 1) and rural versus urban residence (OR 1.22; 95% CI 1.06 to 1.41). CXR rates varied widely, and the odds of early death were highest in the practices which requested more CXRs. Lung cancer incidence at practice level did not affect early deaths.
  
  
  CONCLUSIONS
  Patients who die early from lung cancer are interacting with primary care prediagnosis, suggesting potentially missed opportunities to identify them earlier. A general increase in CXR requests may not improve survival; rather, a more timely and appropriate targeting of this investigation using risk assessment tools needs further assessment.
authors.affiliation: Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK.
authors.forename: Emma L
authors.initials: EL
authors.lastname: O'Dowd
authors.affiliation: Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK.
authors.forename: Tricia M
authors.initials: TM
authors.lastname: McKeever
authors.affiliation: Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Baldwin
authors.affiliation: Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK.
authors.forename: Sadia
authors.initials: S
authors.lastname: Anwar
authors.affiliation: Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Powell
authors.affiliation: Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK.
authors.forename: Jack E
authors.initials: JE
authors.lastname: Gibson
authors.affiliation: Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Iyen-Omofoman
authors.affiliation: Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hubbard
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011859:Radiography; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Clinical Epidemiology; Lung Cancer