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Cited by 145Lung Cancer Diagnosis and TreatmentGlobal Cancer Incidence and ScreeningHealth disparities and outcomes

Treatment and survival disparities in lung cancer: The effect of social environment and place of residence

Johnson, Asal Mohamadi, Hines, Robert B., Johnson, James Allen, Bayakly, A. Rana·2014·Lung Cancer
DOI 10.1016/j.lungcan.2014.01.008
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Abstract

Objective The purpose of this study was to measure the extent to which geographic residency status and the social environment are associated with disease stage at diagnosis, receipt of treatment, and five-year survival for patients diagnosed with non-small cell lung cancer (NSCLC).Methods and materials This study was a retrospective cohort study of the Georgia Comprehensive Cancer Registry (GCCR) for incident cases of NSCLC diagnosed in the state. Multilevel logistic models were employed for five outcome variables: unstaged and late stage disease at diagnosis; receipt of treatment (surgery, chemotherapy, and radiation); and survival following diagnosis. The social and geographical variables of interest were census tract (CT) poverty level, CT-level educational attainment, and CT-level geographic residency status.Results Compared to urban residents, rural and suburban residents had increased odds of unstaged disease (suburban OR=1.23, 95% CI: 1.11-1.37; rural OR=1.63, 95% CI: 1.45-1.83). In this study, rural participants had lower odds of receiving radiotherapy (OR=0.89, 95% CI: 0.82-0.96) and chemotherapy (OR=0.92, 95% CI: 0.85-0.99). Living in CTs with lower educational levels was associated with decreasing odds of receiving both surgery (lowest educational level OR=0.67, 95% CI: 0.59-0.75) and chemotherapy (lowest educational level OR=0.74, 95% CI: 0.68-0.81). Living in areas with higher concentration of deprivation (high level of deprivation HR=1.04, 95% CI: 1.01-1.09) and lower levels of education (lowest educational level HR=1.12, 95% CI: 1.07-1.17) was associated with poorer survival. Rural residents did not show poorer survival when treatment was controlled and they even presented a lower risk of death for early stage disease (HR=0.90, 95% CI: 0.82-0.99).Conclusion This study concludes that where NSCLC patients live can, to some extent, explain treatment and prognostic disparities. Public health practitioners and policy makers should be cognizant of the importance of where people live and shift their efforts to improve lung cancer outcomes in rural areas and neighborhoods with concentrated poverty.

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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 [132]

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Authors
Johnson, A. M., Hines, R. B., Johnson, J. A., & Bayakly, A. R.
Affiliations
  • Georgia Southern University (US)
  • University of Kansas (US)
  • Georgia Department of Public Health (US)
ORCID
Venue
Lung Cancer
Publisher
Elsevier BV
Published
2014-03
Volume
83
Issue
3
Pages
401-407
ISSN
0169-5002 (ISSN-L)
DOI
10.1016/j.lungcan.2014.01.008
OpenAlex
W2090684650
Cited by
145
References
52
Citations by year
2026: 4 · 2025: 11 · 2024: 14 · 2023: 10 · 2022: 18 · 2021: 21 · 2020: 13 · 2019: 12 · 2018: 11 · 2017: 10 · 2016: 11 · 2015: 7 · 2014: 2
FWCI
8.01
Type
journal article
Language
en
Open access
closed
Locations
  • Lung Cancer (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Georgia Southern University
  • Georgia Department of Public Health
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Social Sciences › Health › Health disparities and outcomes
Keywords
non-small cell lung cancer, health disparities, geographic residence, urban-rural differences, social environment, census tract poverty, educational attainment, deprivation, stage at diagnosis, treatment receipt, five-year survival, radiotherapy, chemotherapy, lung cancer surgery, access to cancer care, multilevel logistic model, cancer registry data, public health policy, health equity
MeSH terms
Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung, Female, Georgia, Humans, Lung Neoplasms, Male, Middle Aged, Neoplasm Staging, Poverty Areas, Registries, Residence Characteristics, Retrospective Studies, Social Environment, Socioeconomic Factors, Cohort Studies, Survival Analysis, Rural Health Services, Urban Health Services, Healthcare Disparities, Quality Improvement

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