Neighborhood‐level socioeconomic determinants impact outcomes in nonsmall cell lung cancer patients in the Southeastern United States
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BACKGROUND: Studies examining the impact of lower socioeconomic status (SES) on the outcomes of patients with nonsmall cell lung cancer (NSCLC) are inconsistent. The objective of this study was to clearly elucidate the association between SES, education, and clinical outcomes among patients with NSCLC. METHODS: The study population was derived from a consecutive, retrospective cohort of patients with NSCLC who received treatment within the Duke Health System between 1995 and 2007. SES determinants were based on the individual's census tract and corresponding 2000 Census data. Determinants included the percentage of the population living below poverty, the median household income, and the percentages of residents with at least a high school diploma and at least a bachelor's degree. The SES and educational variables were divided into quartiles. Statistical comparisons were performed using the 25th and 75th percentiles. RESULTS: Individuals who resided in areas with a low median household income or in which a high percentage of residents were living below the poverty line had a shorter cancer‐specific 6‐year survival than individuals who resided in converse areas (P = .0167 and P = .0067, respectively). Those living in areas in which a higher percentage of residents achieved a high school diploma had improved disease outcomes compared with those living in areas in which a lower percentage attained a high school diploma (P = .0033). A survival advantage also was observed for inhabitants of areas in which a higher percentage of residents attained a bachelor's degree (P = .0455). CONCLUSIONS: Low SES was identified as an independent prognostic factor for poor survival in patients with both early and advanced stage NSCLC. Patients who lived in areas with high poverty levels, low median incomes, and low education levels had worse mortality. Cancer 2012. © 2012 American Cancer Society.
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Disparities in race, sex, socioeconomic status, level of education, residence, and insurance status, among other factors, continue to be associated with outcomes such as mortality, incidence, stage at diagnosis, and timely receipt of recommended treatment for patients with NSCLC.
“The results show that disparities in race,128–131 sex,132 socioeconomic status,132–135 level of education,136 residence,128,136 and insurance status,137–139 among other factors, continue to be associated with outcomes such as mortality,128,140 incidence,137,140 stage at diagnosis, and timely receipt of recommended treatment129,131 for patients with NSCLC.”
From Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2015) · cites this paper as [130]
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- Authors
- Erhunmwunsee, L., Joshi, M. M., Conlon, D. H., & Harpole, D. H.
- Affiliations
- Duke University (US)
- Duke Medical Center (US)
- Corresponding author
- Harpole, David H.
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2012-03-05
- Volume
- 118
- Issue
- 20
- Pages
- 5117-5123
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- OpenAlex
- W1498873621
- Cited by
- 72
- References
- 20
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 8 · 2023: 8 · 2022: 5 · 2021: 9 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 4 · 2016: 7 · 2015: 6 · 2014: 4 · 2013: 3
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- non-small cell lung cancer, socioeconomic status, poverty, median household income, educational attainment, cancer-specific survival, prognostic factors, southeastern United States
- MeSH terms
- Adult, Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung, Educational Status, Female, Humans, Lung Neoplasms, Male, Middle Aged, Residence Characteristics, Social Class, Southeastern United States, Healthcare Disparities, Young Adult
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