title: Socioeconomic risk factors for long-term mortality after pulmonary resection for lung cancer: an analysis of more than 90,000 patients from the National Cancer Data Base.
abstract: BACKGROUND
  Several clinical variables, such as tumor stage and age, are well established factors associated with long-term survival after surgical resection of lung cancer. Our aim was to examine the impact of other clinical and demographic variables, controlling for known predictors of long-term survival, in order to investigate how outcomes varied according to important nonclinical factors.
  
  
  METHODS
  The National Cancer Data Base, jointly supported by the Commission on Cancer of the American College of Surgeons and the American Cancer Society, was used to identify patients undergoing pulmonary resection for lung cancer and perform a retrospective cohort study. The cohort consisted of patients diagnosed with nonsmall cell lung cancer from 2003 to 2006, who underwent resection; overall survival data are available only for patients diagnosed through 2006. A Cox proportional hazards survival model was used to examine factors associated with risk of mortality.
  
  
  RESULTS
  A total of 92,929 patients were identified as diagnosed during the study period and undergoing surgical resection for lung cancer. On multivariable analysis, several socioeconomic factors such as lack of insurance, lower income, less education, and treatment at community centers vs academic or research programs predicted worse overall survival after controlling for disease characteristics known to be predictors of worse survival, such as tumor stage, histology, age, and extent of resection.
  
  
  CONCLUSIONS
  Diminished long-term survival after pulmonary resection was associated with a number of socioeconomic factors. To date, this represents the largest database analysis of long-term mortality in patients undergoing surgical resection for lung cancer. The disparities in survival outcomes reported here require further detailed investigation.
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Onkar V
authors.initials: OV
authors.lastname: Khullar
authors.affiliation: Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Gillespie
authors.affiliation: Biostatistics and Bioinformatics Shared Resource at Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
authors.forename: Dana C
authors.initials: DC
authors.lastname: Nickleach
authors.affiliation: Biostatistics and Bioinformatics Shared Resource at Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA; Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Higgins
authors.affiliation: Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Ramalingam
authors.affiliation: Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address: felix.fernandez@emoryhealthcare.org.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000601:surgery; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology