Socioeconomic position and survival after lung cancer: Influence of stage, treatment and comorbidity among Danish patients with lung cancer diagnosed in 2004-2010
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Socioeconomic position and survival after lung cancer : Influence of stage, treatment and comorbidity among Danish patients with lung cancer diagnosed in 2004-2010. / Dalton, Susanne O.; Steding-Jessen, Marianne; Jakobsen, Erik; Mellemgaard, Anders; Østerlind, Kell; Schüz, Joachim; Johansen, Christoffer.
I: Acta Oncologica, Bind 54, Nr. 5, 05.2015, s. 797-804.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Socioeconomic position and survival after lung cancer
T2 - Influence of stage, treatment and comorbidity among Danish patients with lung cancer diagnosed in 2004-2010
AU - Dalton, Susanne O.
AU - Steding-Jessen, Marianne
AU - Jakobsen, Erik
AU - Mellemgaard, Anders
AU - Østerlind, Kell
AU - Schüz, Joachim
AU - Johansen, Christoffer
PY - 2015/5
Y1 - 2015/5
N2 - BACKGROUND: To address social inequality in survival after lung cancer, it is important to consider how socioeconomic position (SEP) influences prognosis. We investigated whether SEP influenced receipt of first-line treatment and whether socioeconomic differences in survival could be explained by differences in stage, treatment and comorbidity.MATERIAL AND METHODS: In the Danish Lung Cancer Register, we identified 13 045 patients with lung cancer diagnosed in 2004-2010, with information on stage, histology, performance status and first-line treatment. We obtained age, gender, vital status, comorbid conditions and socioeconomic information (education, income and cohabitation status) from nationwide population-based registers. Associations between SEP and receipt of first-line treatment were analysed in multivariate logistic regression models and those with overall mortality in Cox regression models with stepwise inclusion of possible mediators.RESULTS: For both low- and high-stage lung cancer, adjusted ORs for first-line treatment were reduced in patients with short education and low income, although the OR for education did not reach statistical significance in men with high-stage disease. Patients with high-stage disease who lived alone were less likely to receive first-line treatment. The socioeconomic difference in overall survival was partly explained by differences in stage, treatment and comorbidity, although some differences remained after adjustment. Among patients with high-stage disease, the hazard ratio (HR) for death of those with low income was 1.12 (95% CI 1.05-1.19) in comparison with those with high income. Among patients with low-stage disease, those who lived alone had a 14% higher risk for dying (95% CI 1.05-1.25) than those who lived with a partner. The differences in risk for death by SEP were greatest in the first six months after diagnosis.CONCLUSION: Socioeconomic differences in survival after lung cancer are partly explained by social inequality in stage, first-line treatment and comorbidity. Efforts should be made to improve early diagnosis and adherence to first-line treatment recommendations among disadvantaged lung cancer patients.
AB - BACKGROUND: To address social inequality in survival after lung cancer, it is important to consider how socioeconomic position (SEP) influences prognosis. We investigated whether SEP influenced receipt of first-line treatment and whether socioeconomic differences in survival could be explained by differences in stage, treatment and comorbidity.MATERIAL AND METHODS: In the Danish Lung Cancer Register, we identified 13 045 patients with lung cancer diagnosed in 2004-2010, with information on stage, histology, performance status and first-line treatment. We obtained age, gender, vital status, comorbid conditions and socioeconomic information (education, income and cohabitation status) from nationwide population-based registers. Associations between SEP and receipt of first-line treatment were analysed in multivariate logistic regression models and those with overall mortality in Cox regression models with stepwise inclusion of possible mediators.RESULTS: For both low- and high-stage lung cancer, adjusted ORs for first-line treatment were reduced in patients with short education and low income, although the OR for education did not reach statistical significance in men with high-stage disease. Patients with high-stage disease who lived alone were less likely to receive first-line treatment. The socioeconomic difference in overall survival was partly explained by differences in stage, treatment and comorbidity, although some differences remained after adjustment. Among patients with high-stage disease, the hazard ratio (HR) for death of those with low income was 1.12 (95% CI 1.05-1.19) in comparison with those with high income. Among patients with low-stage disease, those who lived alone had a 14% higher risk for dying (95% CI 1.05-1.25) than those who lived with a partner. The differences in risk for death by SEP were greatest in the first six months after diagnosis.CONCLUSION: Socioeconomic differences in survival after lung cancer are partly explained by social inequality in stage, first-line treatment and comorbidity. Efforts should be made to improve early diagnosis and adherence to first-line treatment recommendations among disadvantaged lung cancer patients.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Comorbidity
KW - Denmark
KW - Educational Status
KW - Female
KW - Humans
KW - Income
KW - Logistic Models
KW - Lung Neoplasms
KW - Male
KW - Marital Status
KW - Middle Aged
KW - Neoplasm Staging
KW - Odds Ratio
KW - Prognosis
KW - Registries
KW - Severity of Illness Index
KW - Socioeconomic Factors
KW - Time Factors
U2 - 10.3109/0284186X.2014.1001037
DO - 10.3109/0284186X.2014.1001037
M3 - Journal article
C2 - 25761702
VL - 54
SP - 797
EP - 804
JO - Acta Oncologica
JF - Acta Oncologica
SN - 1100-1704
IS - 5
ER -
ID: 162347043